TROPICAL MEDICINE

Introduction
Diseases can be divided into a few large groups according to their main causes.
Most of common diseases in Africa are due to infections by living organisms, viruses, bacteria,
fungi, chlamydiae, richettisia and protozoa.
These are called communicable diseases because they spread from person to person or from
animal to person.
Together with malnutrition, they are today the major cause of illness in Africa.
The communicable diseases occur at all ages but are most serious in childhood due to intensive
exposure and poorly developed immunity.
These diseases are to a large extent preventable. In countries where they have been prevented,
other conditions such as accidents and the degenerative and malignant diseases which occur
mainly at old age, have taken their place and become the commonest.

Why are communicable diseases important in Africa?

o Many of them are very common
o Some of them are very serious and cause death and disability
o Some of them cause widespread outbreaks of the disease- epidemics
o Many of them are preventable by fairly simple means
o Many are particularly serious and more common in infants and children.

Organisms and agents of disease

The living organisms that cause communicable diseases are of different size and sorts.
The largest, like tape or filariae worms are visible to the eyes. They are made of many cells and
are called metazoa.
Complicated but single celled organisms like malaria parasites and amoeba are called protozoa.
They are smaller and can only be seen when magnified with a microscope.
Smaller still are bacteria which are simple, single cell, best seen under a microscope after they
have been stained with dyes.
Rickettisiae and chlamydiae are smaller and can only multiply within cells.
Smallest of all are the viruses. These cannot be seen with an ordinary microscope.

Patterns of communicable diseases

Different diseases are common in different places and different times. To understand why this
happens we need to consider the living organisms of disease- the agent; the people they infect-
the host and the surrounding in which they live- the environment.
The agents need a suitable environment in which to grow and multiply and must be able to
spread and infect other hosts. If they do not succeed in doing this, they die out.
There is therefore a balance between the agent, the host and the environment which can change
and be made to change in different ways.
Environment

AgentHost
Hosts (people) are affected by environment, for example, they may live in a hot climate in which
there many mosquitoes. But people can also change this environment by draining swamps,
changing the vegetation and adding competing hosts such as animals.
Similarly, the environment can affect the agent, for example, the altitude and the temperature for
malaria.

Terminology
Infectious disease
An infectious disease is an illness due to a specific infectious agent or its toxic products that arise
through a transmission of that agent or its products from an infected person, animal or reservoir
to a susceptible host, either directly through an intermediate plant or animal host, vector or
inanimate environment.

Infection
Infection is the entry and development of an infectious agent in the body accompanied by an
immune response.

Disease
Manifestation of infection through symptoms and signs

Exposed
Someone who has met with an infectious agent in a way that is known to cause disease

Colonization
Colonization is the presence of a replicating microorganism without clinical or subclinical
infection or disease. No immune response.
Carrier
Carrier is a person that harbours a specific infectious agent in the absence of clinical disease and
serves as a potential source of infection.

Reservoir
The reservoir of infection is the animal or place in which a particular organism usually lives and
multiplies. Most of the important communicable diseases humans are the main reservoirs.

Route of transmission
The route of transmission is the way in which an organism leaves the infected host or source and
travels to a new susceptible person.

Source
The source of infection is the animal or place from which the particular organism spreads to its
new host.

Incubation period
The incubation period is the time between infection and the appearance of signs and symptoms
of illness.

Epidemiology
Epidemiology is the study of the distribution and patterns of health events, health characteristics
and their causes or influences in a well defined population. Or
It is a branch of medicine that deals with the study of the causes, distribution and control of
diseases in the population.

Endemic
It means the disease is present in the community at all times but in a relatively low frequency
Something that is endemic is typically restricted or peculiar to a locality or region. For example
malaria is endemic in some areas of Africa.

Epidemic
An epidemic is a sudden severe outbreak of an infectious disease that spreads rapidly within a
region or group, affecting a large proportion of people.

Pandemic
A pandemic occurs when an epidemic becomes widespread and affects a whole region, a
continent or the entire world.

Clinical disease
A clinical disease is a disease which has physical manifestations (clinical signs and symptoms).
Susceptible host
A susceptible is someone that is exposed to an infectious disease.

Vector
A vector is an animal, usually an insect that transmits parasitic microorganisms from person to
person or from infected animals to human beings.

Transmission cycle
The transmission cycle describes how organisms grow, multiply and spread.
In some cases humans may be the only host, in which case the infection spreads directly from
person to person, e.g. measles. In other cases, humans are the final hosts from whom the
organism has no chance to pass further, e.g. tetanus.

There are three parts of a transmission cycle for an agent or organism:

Source Transmission Susceptible Host

Source
The source of an infection can be an infected person or animal, or soil. People and animals may
have clinical disease, subclinical disease or be carriers.

Transmission
The main routes of transmission are:
 Direct contact (skin, mucous membrane, sexual intercourse)
 Vector transmission
 Fecal contamination of soil, food and water which are ingested.
 Contact with animals or their products (e.g. biting)
 Airborne transmission (inhalation)
 Transplacental (mother to child) transmission
 Blood contact (injections, surgery, blood transfusion)

Susceptible Host
A susceptible host is one with low resistance to a particular infection. Low resistance may be due
to:
 Not having met the organism before and therefore not having any immunity to it. For
example, at the age of 6-12 months, a child loses the passive immunity against measles
which was acquired from the mother during pregnancy. When in contact with another
child who has measles, the child will develop the disease because of no immunity against
measles
 Having another serious illness like AIDS at the same time. Such people have a higher risk
of developing tuberculosis.
 Malnutrition which can make the infection worse.
Principles of communicable disease control and prevention
The aim of control is to tip the balance against the agent. This may be done by:
 Attacking the source
 Interrupting route of transmission
 Protecting the host

Attacking the Source Interrupting Transmission Protecting the Host

Treatment Environmental sanitation Immunization

Isolation Personal hygiene Chemoprophylaxis

Reservoir control Vector control Personal protection

Notification Disinfection and sterilization Better nutrition