Chapter 10 – Infectious Diseases

A. Infectious Diseases
Key words
 Infectious disease: a disease caused by an organism such as bacterium and viruses.
 Pathogen: organisms that cause disease.
 Disease transmission: the transfer of disease from an infected person to a non-infected person.
 Disease carrier: a person with no symptoms but has the disease.
 Transmission cycle: the passage of a pathogen from one host to another.
 Disease eradication: the complete breakage of the transmission cycle.
 Endemic disease: a disease that is always in a population.
 The incidence of a disease is the number of people who are diagnosed over a certain period of time,
a month week or year.
 The prevalence of a disease is the number of people who have that disease at any one time.
 An epidemic occurs when there is a sudden increase in the number of people with a disease.
 A pandemic occurs when there is an increase in the number of cases throughout a continent across
the world.
 Mortality rate is the number of deaths over a particular length of time usually a year.

What are infectious diseases?

 Infectious diseases are diseases that are caused by organisms known as pathogens.
 They are sometimes called communicable diseases as they are passed from infected to uninfected
people.
 Some diseases also affect animals and are passed from animals to humans.
 ‘Disease’ is a difficult word to define as it covers a wide range of human conditions.
 it is often defined as an illness or disorder of the body or mind that leads to poor health.
 Each disease is associated with a set of signs and symptoms.
 Many infectious diseases, such as the common cold, measles and influenza, affect us for a short
period of time.
 Others, such as tuberculosis (TB), may last a much longer time.
 In the case of HIV/AIDS, there is as yet no cure, and treatments must be taken for the rest of the
person’s life.
 Some infectious diseases can only spread from one person to another by direct contact, because the
pathogen cannot survive outside the human body.
 Other pathogens can survive in water, human food, faeces or animals (including insects), and so are
transmitted indirectly from person to person.

Ways to prevent diseases

 Vaccination is a major control measure for many infectious diseases.

 Vaccination works by making us immune to specific pathogens so that they do not live and
reproduce within us and do not spread to others, so breaking the transmission cycle.
 The World Health Organization (WHO), are reducing the impact of these diseases. The WHO has
campaigns designed to stop all transmission of some diseases so leading to their eradication. Two
 diseases have so far been eradicated. In 1980, the WHO declared that smallpox had been
eradicated. In 2011, rinderpest, a severe disease of livestock, was eradicated.

Names and types of pathogens that cause infectious diseases

1. Cholera
a. What is Cholera?
A bacterial disease that causes severe diarrhea and dehydration, usually spreads in water.
Cholera is caused by a bacterium called Vibrio cholerae.

b. Why is it dangerous
It is important to maintain the osmotic balance of the blood and tissue fluids. People with severe
cholera can develop severe dehydration, which can lead to kidney failure.

c. Features of Cholera
 Pathogen
Vibrio Cholerae
 Methods of transmission
Food borne, water-borne
 Global distribution
Asia, Africa, Latin America
 Incubation period
Two hours to five days

d. Transmission of Cholera
 How is it transmitted from person to person?
Carriers pass out large numbers of bacteria in their faeces. Hence, Cholera occurs where
people do not have access to proper sanitation and/or uncontaminated food.
 Examples:
 Faeces contaminating the water supply
 Infected people handle cooking utensils without washing their hands
 “Cholera remains a global threat to public health and an indicator of inequity and lack of
social development.” - World Health Organization
 Transmission:
1. Through the stomach
To reach the site of action in the small intestine, the bacteria have to pass through the
stomach. If the stomach’s contents are sufficiently acidic (pH less than 4.5), they are
unlikely to survive.
 2. Reach the small intestine
They multiply and secrete the toxin choleragen. Disrupting the functions of the
epithelium lining. Causing the salts and water leave the blood which causes severe
diarrhea.
3. Diarrhea, dehydration
Cholera is fatal if not treated immediately.
The main symptoms are diarrhea and dehydration.

e. Treating Cholera
 If patient can drink: “Oral Rehydration Therapy”
ORT is an incredibly simple therapy, a mixture of water, salt and sugar. It can be administered
orally
 If patient cannot drink: “Intravenously Given”
The solution is given intravenously to rehydrate the body. To be carried within the blood.
 These patients are also given appropriate antibiotic to diminish the duration of diarrhea.

f. Preventing Cholera
 Improving sanitation
Sewage treatment and the provision of clean piped water, which is chlorinated to kill
bacteria.
 Vaccine
An oral vaccine that gives short- term protection against cholera was approved in the USA in
2016.

g. Questions

Ans: A
2. Malaria
a. Transmission of malaria
 What is malaria?
Malaria is a diseases that is caused by pathogens. The pathogens are Plasmodium falciparum,
Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae.
 Female Anopheles
The female Anopheles mosquito is the disease vector (The one who carries the pathogen and
transmits it from one person to another or from an animal to human) of malaria.

b. Methods of transmission
 Through Insect vector (Main)
The female Anopheles will bite a human and introduce the parasite into our bloodstream and
then the liver cells.
 Transfusion of blood
Malaria infection through blood transfusion can occur if blood donors have malaria in their
blood.
 Re-used unsterile needles
Needles that are not sterile have the possibility of infecting us if they have been
contaminated with infected blood.

c. Features of malaria
 Global distribution:
worldwide
 Site of action of pathogen
Liver, brain, red blood cell
 Method of diagnosis

 Red Blood cells infected with Plasmodium falciparum (P. 242)

 TEM of a section through a blood cell packed with malarial parasites (P. 243)
d. Clinical features of malaria
 Fever
 Anaemia
 Nausea
 Headaches
 Muscle pain
 Shivering
 Sweating
 Enlarged Spleen

e. Treating malaria
Malaria disease should be confirm by using a test that shows the presence of Plasmodium before
treatment is started
1) Clinical diagnosis
is based on the patient’s symptoms and on physical findings at examination. First symptoms
of malaria (most often fever, chills, sweats, headaches, muscle pains, nausea and vomiting)
are often not specific

2) Microscopic diagnosis
 Malaria parasites <Malaria parasites are microorganisms that belong to the genus
Plasmodium> can be identified by examining under the microscope a drop of the patient’s
blood
3) Antigen detection
an alternate way of quickly establishing the diagnosis of malaria infection by detecting
specific malaria antigens in a person’s blood

Anti-malarial drugs such as quinine and chloroquine is used to treat infected people
1) Quinine
Quinine works by killing the parasite or preventing it from growing

2) Chloroquine
Used as prophylactic /preventive drugs, stopping an infection occurring if a person is bitten
by an infected mosquito

How does Chloroquine works?

 Chloroquine inhibits the protein synthesis in the parasite lysate and prevents the parasite
spreading within the body
 Another prophylactic, proguanil, has the added advantage of inhibiting the sexual
reproduction of plasmodium inside the biting mosquito

prophylactic drugs
prophylactic drugs are taken before, during and after visiting an area where malaria is
endemic

Chloroquine-resistant Plasmodium falciparum

 Chloroquine-resistant P. falciparum first developed in Southeast Asia, South America, and
Africa in the late 1950s and early 1960s.
 Mefloquine is used in some areas, however, this might cause unpleasant side-effects such
as restlessness, dizziness, and vomiting
 P. falciparum has also developed resistance to many antimalarial drugs, such as
mefloquine, halofantrine, and quinine.
 Currently the best available treatment for this is artemisinin-based combination therapy.

f. Preventing malaria
There are three main ways to control malaria:
1) Reduce the number of mosquitoes
2) Avoid being bitten by mosquitoes
3) Use prophylactic drugs to prevent Plasmodium infecting people

Most effective method is to kill the insect vector and break the transmission cycle
How do we break the transmission cycle?
Spread oil over the surface of water so larvae and pupae can't breathe. reduce the breeding
sites for mosquitoes
 Two biological ways to control malaria:
1) Ponds, irrigation, and other permanent bodies of water with fish which feed on
mosquito larvae
2) Spraying a preparation containing the bacterium, Bacillus thuringiensis, which kills
mosquito larvae

Protection against malaria

1) Sleep beneath mosquitoes nets
2) Use mosquitoes repellents
3) Spray insecticide

Vaccine
The World Health Organization recommends widespread use of the RTS,S/AS01 (RTS,S)
malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to
high P. falciparum malaria transmission.

Three factors
that may lead to improvements in the control of malaria
1) Use of modern techniques in gene sequencing and drug design
2) Development of vaccines targeted against different stages of the parasite's life cycle
3) To remove the burden of malaria from the poorest parts of the world, allied to generous
donations from wealthy individuals and foundations

Can a person with malaria spread it?

Malaria is not contagious and you can't catch it from physical contact with someone who has
it. However, People with untreated or inadequately treated malaria may spread infection to
a mosquito that bites them.

g. Questions

Ans: D

Ans: D
 Ans: C

3. HIV/AIDS
a) HIV
 Human Immunodeficiency Virus
 A Virus that attacks the immune system (T-helper lymphocytes), liver, brain, etc.
 Transmitted only by direct exchange of body fluids
 The Infection is flu-like symptom, then symptomless
 2-6 weeks incubation period

b) AIDS
 Acquired Immunodeficiency Syndrome
 A deficiency of the body’s immune system that’s caused by HIV
 AIDS opens the opportunity for infections of other viruses including pneumonia, TB and
cancers caused by virus (opportunistic infection)

c) Transmission of HIV
 Semen and vaginal fluids during sexual intercourse
 Infected blood or blood products
 Contaminated hypodermic syringes
 Mother to fetus across placenta and at birth
 Mother to infant in breast milk

d) Treating HIV/AIDS
 People who cannot follow the pattern and timing of medication can become susceptible to
the strain of HIV that has developed resistance to the drugs.
 There is no cure for AIDS and no vaccine for HIV.
 People use drugs so they can live with HIV. Drug therapy can slow down the onset of AIDS.
 Side effects of drugs
Drugs are expensive and have a variety of side effects.
Mild and temporary: rashes, headaches, diarrhea
Severe and Permanent: nerve damage, abnormal fat distribution
 Two or more drugs combined to prevent replication of the virus inside the host cells which
can prolong life, but they are not a cure.
  Zidovudine is one example of the drug that is used to treat HIV. It stops the replication and
increase the body’s lymphocytes.

e) Preventing HIV/AIDS
1) Educate people about the spread of the infection and encouraged to change their behaviour
2) Use condoms, femidoms, or dental dams to reduce the risk of infection during intercouse
3) Contact tracing to identify the person has put at risk of infection by sexual intercourse
4) For those that have been exposed to the virus, stop sharing needles or donating blood
5) Avoid breastfeeding to prevent mother-to-child transmission

f) Questions

Ans: C
HIV might lead to AIDS that opens higher opportunity for other infections such as TB.

Ans: D
HIV attacks the T-lympochytes, the cell that controls the response of the immune system to
other pathogens, which create higher opportunity for other pathogens to infect such as
malaria. C is wrong since malaria do not use the T-lymphocytes that are infected by HIV.

Ans: D
HIV/AID and measles are both caused by viral infection which cannot be treated with
antibiotics, that are treatment for bacterial infections.
4. Tuberculosis (TB)
a) Features of TB
 Pathogen
Mycobacterium tuberculosis; Mycobacterium bovis
 Methods of transmission
Airborne droplets (M. tuberculosis); via undercooked meat and unpasteurised milk
 Global distribution
Worldwide
 Incubation period
A few weeks or up to several years
 Side of action of pathogen
Primary infection in lungs, secondary infection in lymph nodes, bones and gut
 Clinical features
Racking cough, cough blood, chest pain, shortness of breath, fever, sweating, weight loss
 Methods of diagnosis
Rapid molecular test presence of DNA from M. tuberculosis, chest X-ray,

b) Transmission of TB
 When infected people with the active form of
the disease cough or sneeze, the Mycobacterium
tuberculosis bacteria enter the air in tiny
droplets of liquid.
 TB is transmitted when uninfected people then
inhale these droplets.
 Some people become infected and develop TB
quite quickly, whilst in other the bacteria remain
inactive for many years.
 Factors that influence the spread of tuberculosis:
1) People live in poorly ventilated and overcrowded conditions
2) Low immunity (due to malnutrition or HIV-positive)
3) Some strain of TB bacteria are resistant to Drugs
4) The breakdown of TB control Programmes
 The form of TB caused by Mycobacterium bovis occurs in cattle but is spread to humans
through contaminated meat and unpasteurised milk
 However, as with M. tuberculosis, not everyone infected with M. bovis becomes sick. People
who are infected but not sick have what is called latent TB infection (LTBI)
 M. bovis causes a relatively small proportion, less than 2%, of the total number of cases of TB
disease in the US

c) Treating TB
 Identification: Sputum Test
Other test to detect TB:
1) Mantoux tuberculin skin test (TST)
2) Blood Test
 Sputum is the mucus that comes up when you cough.
A sample of the sputum will be added to culture media in order to grow the organism so
that it can be correctly identified as TB
If no bacteria grow, the culture is negative.
If bacteria grow, the culture is positive.
Treatment for Active TB:
1) 2 antibiotics (isoniazid and rifampicin) for 6 months
2) 2 Additional antibiotics (pyrazinamide and ethambutol)
Treatment for latent TB:
1) Either taking a combination of rifampicin and isoniazid for 3 months
2) Isoniazid on its own for 6 months
DOTS (Direct Observation Treatment, Short Course

d) Drug-Resistance TB
 Drug-resistance TB is a man-made phenomenon which occurs where bacteria is being resistant
to the drugs used to treat TB.
 This occurs as a result of mutation in the bacterial DNA
 FIRST-LINE TREATMENT
If a person stops their TBC treatment, it makes higher mutations. This makes the M.
tuberculosis bacteria develop resistance to the drugs in use. this type of resistance is called
MDR-TB (multiple-drug resistance).

 SECOND-LINE TREATMENT
This is a treatment for MDR-TB. If the person stops taking the medication for MDR-TB, this will
result in XDR-TB (extensive or extreme drug-resistant)

 PREVENTION & CONTROLS OF TB

1) To control TB, contact tracing and testing of contacts are essential. A TB diagnosis may take
up to two weeks after the contact is screened for symptoms.
2) Prevention can through BCG vaccine (the only vaccine for TB).
3) Routinely testing cattle for TB and destroying those that test positive
4) Pasteurising milk (kills any TB-causing bacteria present in the milk)
5) Ensuring meat is cooked properly
e) Questions

Ans: B

Ans: D

Ans: D

Ans: D
B. Antibiotics
ANTIBIOTICS
a) What are antibiotics?
Key Definition: a substance derived from a living organism that is capable of killing or inhibiting the
growth of a microorganism

Note*
Some antibiotics are derived from living organisms (eg. penicillin is produced by certain fungi in the
genus Penicillium), whilst other are made synthetically (in a laboratory)

b) How antibiotics work?

Antibiotics work by interfering with the growth or metabolism of the target bacterium.
Antibiotics target a variety of processes including:
1) synthesis of bacterial cell walls
2) activity of proteins in bacterial cell surface membranes
3) bacterial enzyme action
4) bacterial DNA synthesis
5) bacterial protein synthesis

c) Penicillin: Why it Affects Bacteria & Not Viruses

Bacteria The roe of Penicillin

Cell walls are composed of peptidoglycans
(long molecules of peptides and sugars
When a new cell is growing, it secretes
enzymes autolysins (create small holes in the
cell wall)
The holes allow the cell wall to stretch with
new peptidoglycan molecules joining up via
cross-links (peptidoglycan held together)
Stops the cross-links to form by inhibiting
enzymes (autolysins catalyse the formation of
cross-links)
Bacterial cell wall gets weaker and weaker
(autolysins keep forming holes)
As bacteria live in watery environments and
take up water by osmosis, their weakened cell
walls eventually burst as they can no longer
withstand the pressure exerted on them from
within the cell (see diagram below)

How Penicillin Affects Bacteria

d) Why Not Viruses?
 Penicillin is not effective against all bacteria (eg. tuberculosis) because the bacteria may have:
1) Thick cell walls which reduce permeability
2) Enzymes which breakdown penicillin
 Antibiotics do not affect viruses as they do not have cells, yet alone a cell wall. Therefore,
viruses cannot be targeted in any of the ways that an antibiotic targets a bacterial cell.

e) Questions

Ans: A

Ans: C

ANTIBIOTIC RESISTANCE

a) Penicillin
 Wonder Drug
Was hailed as killer of all sickness
 Overused
Abused, misused, and overused
 Evolution
Bacterial evolution to fight and resist - new coding
 Immunity
Certain bacteria are now immune - penicillinase
 Ineffective
Largely ineffective against most infections

Note: Mutation can also cause resistance, it is the initial mechanism

 An enzyme which destroys the antibacterial activity of penicillin by hydrolyzing the amide bond
in the beta-lactam ring. [Penicillinase]
b) Why Is A.R. So Significant?
 Heightened risks of death
 Passing on resistance
 Human-bacteria arms race
 Non-pathogenic turned pathogenic

c) We Are Losing The War?

W.H.O. (The World Is Running Out of Antibiotics) report:
 12 classes of priority pathogens identified
 Some causing common infections such as pneumonia, all becoming resistant
 51 new antibiotics being researched and made to treat priority bacteria disease such as TBC
 Only 8 were marked to be significant
 250,000 – Annual Drug Resistant TBC Deaths

d) What to do?
1) Use antibiotics when necessary, not prescribed when viral
2) Reducing number of countries where antibiotics are sold without prescriptions
3) Do not wide-spectrum antibiotics. But, narrow-spectrum (specialised) antibiotics
4) Ensuring completion of medication course

e) Further Things To Do!

 Unused antibiotic
Ensure that patients do not keep unused antibiotics for future use/to be given
 Varied antibiotics
Usage of different antibiotics to treat different diseases or sicknesses
 Farm use
Avoid Antibiotics in farms being used to prevent - more preferable to be used to cure instead

f) Questions

Ans: A
Ans: D