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1yphold lever

1yphold fever ls a llfeLhreaLenlng lllness caused by Lhe bacLerlum Salmonella 1yphl lL belongs Lo Lhe
Salmonella group whlch conLalns nearly 2000 dlfferenL Lypes causlng mlld dlseases such as food
polsonlng Lhrough Lo Lhe more serlous dlsease of Lyphold fever araLyphold fever ls a slmllar buL
less severe varlanL lL ls a common lllness ln Lhe developlng world where lL affecLs abouL 123 mllllon
people each year 1yphold fever occurs ln mosL parLs of Lhe world excepL ln developed counLrles
such as Lhe unlLed klngdom WesLern Lurope uSA Canada AusLralla new Zealand and !apan
1herefore lf you are Lravellng Lo Lhe developlng world you should conslder Laklng precauLlons
1ravellers Lo Asla Afrlca and LaLln Amerlca are especlally aL rlsk
1he Lyphold fever bacLerla ls carrled ln Lhe bloodsLream and lnLesLlnal LracL of lnfecLed persons A
small number of persons called carrlers recover from Lhe fever buL conLlnue Lo carry Lhe bacLerla
8oLh lll persons and carrlers shed Lhe bacLerla ln Lhelr feces ulagnosls requlres medlcal oplnlon and
examlnaLlon of Lhe blood
?ou can geL Lyphold fever lf you eaL food or drlnk beverages LhaL have been conLamlnaLed by a
person who ls sheddlng S 1yphl or lf sewage conLamlnaLed wlLh S 1yphl bacLerla geLs lnLo Lhe waLer
you use for drlnklng or washlng food 1herefore Lyphold fever ls more common ln areas of Lhe world
where handwashlng ls less frequenL and waLer ls llkely Lo be conLamlnaLed wlLh sewage
1he lncubaLlon perlod depends on Lhe quanLlLy of Lhe bacLerla swallowed and can vary from one Lo
Lhree weeks ersons wlLh Lyphold fever usually have a susLalned fever as hlgh as 39 or 40 C 1hey
wlll also feel weak have sLomach palns headache and loss of appeLlLe ln some cases paLlenLs have
a rash of flaL rosecolored spoLs
1reaLmenL 1yphold fever ls usually LreaLed wlLh anLlbloLlcs such as amplclllln or clprofloxacln whlch
are very effecLlve buL should ldeally be glven under medlcal supervlslon PosplLal admlsslon may be
more approprlaLe abroad ersons LreaLed wlLh anLlbloLlcs usually lmprove wlLhln 2 Lo 3 days and
deaLhs rarely occur Powever relapse ls noL uncommon and paLlenLs may develop Lhe carrler sLaLe
afLer LreaLmenL lL ls Lherefore very lmporLanL Lo have your sLools examlned on your reLurn lf you
have been LreaLed for Lyphold abroad
WlLhouL LreaLmenL Lhls lllness can be faLal!! ersons who do noL recelve LreaLmenL may conLlnue Lo
have Lhe fever for weeks or monLhs and as many as 20 may dle from compllcaLlons such as
perlLonlLls resulLlng from perforaLlon of Lhe guL wall
1yphold fever can be prevenLed and can usually be LreaLed wlLh anLlbloLlcs lf you are plannlng Lo
Lravel Lo a reglon where lL exlsLs you should know abouL lL and whaL sLeps you can Lake Lo proLecL
yourself 1here are Lwo baslc acLlons LhaL can help Lo proLecL you from Lyphold fever

1 CeL vacclnaLed agalnsL Lyphold fever
2 Avold rlsky foods and drlnks
WaLchlng whaL you eaL and drlnk when you Lravel ls [usL as lmporLanL as belng vacclnaLed 1hls ls
because Lhe vacclnes are noL compleLely effecLlve Avoldlng rlsky foods wlll also help proLecL you
from oLher lllnesses lncludlng Lravelers dlarrhoea cholera dysenLery and hepaLlLls A
1eLanus ls a poLenLlally faLal dlsease whlch ls caused by an lnfecLlon of Lhe bacLerlum ClosLrldlum
1eLanl 1he bacLerla enLer Lhe body Lhrough a wound where Lhey grow and produce a powerful Loxln
whlch clrculaLes ln Lhe blood and causes muscular rlgldlLy and palnful muscle conLracLlons ueaLh ls
usually caused by resplraLory problems and exhausLlon
1eLanus spores are presenL ln soll worldwlde and may be lnLroduced lnLo Lhe body durlng ln[ury
Lhrough a puncLure wound burn or Lrlvlal unnoLlced wounds
1eLanus can be conLracLed qulLe easlly Lhrough a small wound such as a scraLch Lhrough whlch Lhe
organlsm can geL lnLo Lhe body 1here have been reporLed cases of LeLanus ln whlch Lhe paLlenL
cannoL even remember Lhe ln[ury slnce lL was so small and lnslgnlflcanL

Whlle vacclnaLlon has largely dlmlnlshed Lhe lncldence of LeLanus Lhe dlsease has noL dlsappeared
lf lndlvlduals are noL fully lmmunlsed Lhere ls always Lhe rlsk of LeLanus developlng ln wounds
conLamlnaLed by soll 1he lncubaLlon perlod ls beLween four and LwenLy one days commonly
around Len days
1he flrsL slgn of LeLanus ls when Lhe paLlenL may noLlce [aw sLlffness and dlfflculLy ln openlng Lhe
mouLh (lock [aw)
1reaLmenL 8equlres medlcal supervlslon ln hosplLal
revenLlon All wounds even mlnor ones should be Lhoroughly washed wlLh clean waLer and soap
Laklng parLlcular care Lo remove all dlrL and loose Llssue
lmmunlsaLlon agalnsL LeLanus ls hlghly proLecLlve and adulLs and chlldren should ensure Lhey are ln
daLe for lL 8oosLer doses should be glven aL Len year lnLervals
8oosLer doses ln addlLlon Lo flve doses are noL recommended excepL ln Lhe case of Lhe LreaLmenL of
a LeLanusprone wound 1he ueparLmenL of PealLh advlsed ln 2002 LhaL LeLanus vacclne ls Lo be
replaced by Lhe comblned LeLanus/low dose dlphLherla vacclne for adulLs and adolescenLs for
rouLlne use and for Lravel vacclnaLlon SLocks of slngle LeLanus vacclne are now exhausLed and
companles are no longer supplylng Lhls producL

ollomyellLls (pollo)

ollomyellLls normally referred Lo as pollo ls caused by a vlrus whlch ls spread from personLo
person prlmarlly Lhrough faecal conLamlnaLlon of food and waLer alLhough lL can also be spread by
dropleL Lransfer

lnlLlally lnfecLlon of Lhe guL can spread Lo Lhe splnal cord or braln where lL can cause paralysls ln
Lhe days before wldespread vacclnaLlon lL Lended Lo occur ln epldemlcs

1ravellers who have noL been lmmunlsed or whose lmmunlLy has waned are aL rlsk lf Lhey are
Lravelllng Lo areas of Lhe world where pollo sLlll occurs le nlgerla nlger lndla aklsLan and
AfghanlsLan are parLlcularly hlgh rlskln many cases lnfecLlon wlLh Lhe pollo vlrus ls asympLomaLlc
When sympLoms do occur Lhe onseL of pollo ls sudden wlLh fever headache nausea and vomlLlng
as Lhe vlrus mulLlplles ln Lhe guL 1he vlrus Lhen lnvades Lhe blood sLream and nervous sysLem
aralysls occurs ln less Lhan 1 ln 100 cases of lnfecLlon 1hls rlsk lncreases wlLh age 1he paLlenL may
dle lf Lhe resplraLory and swallowlng muscles are affecLed 1hose who survlve may develop resldual
paralysls Severe paln and wasLlng are common ln paralysed muscles 8ecovery can Lake up Lo a
year 1he lncubaLlon perlod ls 714 days A blood LesL for anLlbodles wlll conflrm Lhe dlagnosls
alLhough Lhls ls noL always avallable abroad aLlenLs are lnfecLlous by close conLacL and should be
lsolaLed for aL leasL a week
1reaLmenL 1he developmenL of paralysls ls clearly an emergency and medlcal help should be soughL
wlLhouL delay lf Lhe paralysls affecLs Lhe breaLhlng muscles arLlflclal means of resplraLlon may be
requlred LxLreme care should be Laken when dlsposlng of excreLa for up Lo 6 weeks

revenLlon 1here ls an effecLlve vacclne avallable 1en yearly boosLers should be glven Lo ensure
maxlmum lmmunlLy and Lravellers should ensure Lhey are ln daLe for pollo lmmunlsaLlon
asL lnfecLlon wlLh pollo does noL always glve compleLe proLecLlon as Lhere are Lhree sLralns of Lhe
As Lhe dlsease ls usually spread Lhrough close conLacL Lry Lo avold crowded places ln hlgh rlsk areas
as much as posslble (buses Lralnspubllc swlmmlng pools) 1hls could prove dlfflculL ln some
counLrles such as lndla 1herefore vacclnaLlon would be lmperaLlve lf Lravelllng Lhere

1he World PealLh CrganlsaLlon ls maklng greaL efforLs Lo encourage wldespread use of pollo vacclne
ln an aLLempL Lo eradlcaLe pollo from all Lhe counLrles of Lhe world Many counLrles have already
been cerLlfled pollo free by Lhe WPC 8y 1994 Lhe Amerlcas were cerLlfled as pollofree

PepaLlLls A

1hls ls a vlral dlsease LhaL causes lnflammaLlon of Lhe llver lL occurs worldwlde and ls especlally
prevalenL ln areas of poor sanlLaLlon and hyglene
Many chlldren ln developlng counLrles are lnfecLed wlLh Lhe vlrus aL an early age usually wlLhouL
sympLoms asL lnfecLlon wlLh hepaLlLls A vlrus glves llfe long lmmunlLy
Powever ln Lhe developed world where sanlLaLlon ls beLLer fewer people are conLracLlng Lhe
dlsease durlng chlldhood and are Lherefore aL rlsk when Lhey become adulLs from Lhe more severe
form of Lhe dlsease whlch Lhey could caLch when Lhey Lravel Lo areas of Lhe world where hepaLlLls A
ls more common 1he map below shows Lhe global lncldence of PepaLlLls A
1he vlrus ls LransmlLLed from personLoperson by Lhe faecaloral rouLe parLlcularly ln areas wlLh
poor sanlLaLlon and overcrowdlng lL ls qulckly spread Lhrough close conLacL parLlcularly wlLhln
famllles and lnsLlLuLlons and ls commonly assoclaLed wlLh eaLlng and drlnklng conLamlnaLed food
and waLer lood ouLbreaks are ofLen llnked Lo raw or undercooked shellflsh and raw vegeLables
alLhough almosL any food can be lmpllcaLed whlch has been poorly cooked ln sewagepolluLed waLer
PepaLlLls A has a wlde range of sympLoms from an lnfecLlon wlLhouL any noLlceable sympLoms
Lhrough Lo [aundlce llver fallure and deaLh unllke hepaLlLls 8 Lhere ls no chronlc carrler sLaLe for
hepaLlLls A
SympLoms lnclude fever chllls weakness loss of appeLlLe nausea and abdomlnal dlscomforL
followed wlLhln a few days by [aundlce (yellowlng of Lhe skln and eyes) 1he urlne becomes dark and
Lhe sLools pale !aundlce may be severe and prolonged and compleLe llver fallure may occur

revenLlon Avold conLamlnaLed food and waLer

PepaLlLls A can be prevenLed by vacclnaLlon 1he lmmunlsaLlon schedule conslsLs of a slngle dose of
vacclne followed by a boosLer dose slx Lo Lwelve monLhs afLer Lhe flrsL dose Lo glve lmmunlLy up Lo
Len years


Cholera ls a bacLerlal lnfecLlon of Lhe gasLrolnLesLlnal LracL caused by Lhe bacLerlum vlbrlo Cholerae

1hese bacLerla are Lyplcally lngesLed by drlnklng waLer conLamlnaLed by lmproper sanlLaLlon or by
eaLlng lmproperly cooked flsh especlally shell flsh

AbouL one mllllon vlbrlo cholerae bacLerla musL be lngesLed Lo cause cholera ln normally healLhy
adulLs alLhough lncreased suscepLlblllLy may be observed ln Lhose wlLh weakened lmmune sysLems
lndlvlduals wlLh decreased gasLrlc acldlLy (as from Lhe use of anLaclds eLc) or Lhose who are
malnourlshed 1he lncubaLlon perlod ls usually Lwo Lo Lhree days buL may only be a few hours

SympLoms range from Lhe mlld Lo Lhe severe whlch may be faLal and lnclude dlarrhoea abdomlnal
cramps nausea vomlLlng and dehydraLlon

vlbrlo cholerae causes Lhe dlsease by produclng a Loxln LhaL lnduces severe palnless waLery
dlarrhoea of sudden onseL occaslonally accompanled by vomlLlng whlch rapldly leads Lo
dehydraLlon 1he profuse dlarrhoea allows Lhe bacLerlum Lo spread Lo oLher people under lnsanlLary

1he bacLerla are LransmlLLed ln waLer or food conLamlnaLed wlLh lnfecLed faeces and Lhe dlsease
can occur ln largescale epldemlcs where sanlLary condlLlons have broken down such as Lhose ln
areas of naLural dlsasLers

Cholera ls rare amongsL Lravellers as Lhey Lend Lo avold Lhe lnsanlLary condlLlons whlch would puL
Lhem aL rlsk

1reaLmenL Medlcal help should be soughL wlLhouL delay Cholera ls LreaLed wlLh rehydraLlon and
anLlbloLlcs buL ln severe cases can lead Lo deaLh

lluld replacemenL ls essenLlal and should be sLarLed as soon as sympLoms occur 1he paLlenL should
alm Lo drlnk as much nonalcohollc fluld as lL Lakes Lo malnLaln a good ouLpuL of normal looklng
urlne (Lhls may be as much as slx or seven llLres a day)

revenLlon Avold conLamlnaLed food and waLer especlally raw or undercooked seafood from
polluLed waLer

1here ls a new vacclne (uukoral) for lmmunlsaLlon agalnsL cholera for people Lravelllng Lo hlghly
endemlc or epldemlc areas parLlcularly emergency rellef and healLh workers ln refugee slLuaLlons
1he vacclne may be consldered for Lhe followlng
eople worklng ln areas where Lhere are known cholera ouLbreaks (eg ald workers)
1ravellers sLaylng for long perlods ln known hlgh rlsk areas and/or where close conLacL wlLh locals ls
llkely and who do noL have access Lo medlcal care
1ravellers Lo rlsk areas who have an underlylng gasLrolnLesLlnal dlsease or lmmune suppresslon

1he vacclne ls Laken as a raspberry flavoured drlnk and can be used ln adulLs and chlldren over 2

lL ls noL currenLly llcensed ln Lhe uk for Lravellers dlarrhoea

MenlnglLls (Menlngococcal)

MenlnglLls ls an lnfecLlon LhaL causes lnflamaLlon of Lhe membranes and fluld LhaL surrounds Lhe
braln and splnal cord lL can be caused by a vlral or bacLerlal lnfecLlon

vlral menlnglLls ls generally less severe and resolves wlLhouL speclflc LreaLmenL whlle bacLerlal
menlnglLls (menlngococcal) can be qulLe severe and may resulL ln braln damage coma or even deaLh

lL can occur ln epldemlcs especlally where large crowds are gaLhered as lL ls acqulred Lhrough dlrecL
conLacL or lnhalaLlon of bacLerla ln dropleLs coughed or sneezed lnLo Lhe alr

Larly dlagnosls and LreaLmenL are very lmporLanL lf sympLoms occur Lhe paLlenL should seek
medlcal help lmmedlaLely Medlcal supervlslon ls requlred slnce large doses of anLlbloLlcs are
employed 1reaLmenL should be sLarLed wlLhouL delay ldenLlflcaLlon of Lhe Lype of bacLerla
responslble ls helpful for Lhe selecLlon of correcL anLlbloLlcs

Plgh fever headache and sLlff neck and a bloLchy rash are common sympLoms 1hese can develop
over several hours or Lhey may Lake 1 Lo 2 days CLher sympLoms may lnclude nausea vomlLlng
dlscomforL wlLh brlghL llghLs confuslon and sleeplness As Lhe dlsease progresses paLlenLs may
develop selzures before golng lnLo a coma

Sporadlc cases of menlnglLls are found worldwlde ln LemperaLe zones mosL cases occur ln Lhe
wlnLer monLhs Locallzed ouLbreaks occur ln enclosed crowded spaces (eg dormlLorles mlllLary
barracks) ln subSaharan Afrlca ln a zone sLreLchlng across Lhe conLlnenL from Senegal Lo LLhlopla
(known as Lhe Afrlcan menlnglLls belL") large ouLbreaks and epldemlcs Lake place durlng Lhe dry
season (november!une)

8acLerlal menlnglLls ls conLaglous 1he bacLerla are spread by dlrecL person Lo person conLacL
lncludlng aerosol Lransmlsslon and exchange of resplraLory and LhroaL secreLlons (le sneezlng
coughlng klsslng eLc)

lorLunaLely none of Lhe bacLerla LhaL cause menlnglLls are as conLaglous as Lhe vlruses LhaL spread
Lhe common cold or lnfluenza and Lhey are noL spread by casual conLacL or by slmply breaLhlng Lhe
alr where a person wlLh menlnglLls has been

1he rlsk Lo Lravellers ls generally low Powever Lhe rlsk ls conslderable lf Lravellers are ln crowded
condlLlons or Laklng parL ln large populaLlon movemenLs such as pllgrlmages eg Lhe Pa[ Lo Mecca
Locallzed ouLbreaks occaslonally occur among Lravellers (usually young adulLs) ln camps or
dormlLorles 8ackpackers who use crowded hosLels wlll be aL greaLer rlsk durlng an ouLbreak

revenLlon Avold overcrowded places and close conLacL wlLh Lhe local populaLlon

1here are Lwo vacclnes used Lo proLecL Lravellers 1he menlnglLls A + C vacclne and Lhe menlnglLls
ACW? vacclne 1he laLLer ls requlred for pllgrlms and seasonal workers vlslLlng Saudl Arabla

LffecLlve LreaLmenL ls underLaken wlLh a number of anLlbloLlcs lL ls lmporLanL however LhaL
LreaLmenL be sLarLed early ln Lhe course of Lhe dlsease 1hls wlll reduce Lhe rlsk of morLallLy Lo below
13 alLhough Lhe rlsk ls hlgher among Lhe elderly


ulphLherla ls an lnfecLlon caused by a bacLerlum called CorynebacLerlum dlphLherlae LhaL causes a
moderaLely sore LhroaL SomeLlmes Lhe llnlng of Lhe LhroaL may swell Lo form a false membrane
whlch can cause dlfflculLles ln breaLhlng

ln lLs early sLages dlphLherla may be mlsLaken for a severe sore LhroaL ln severe cases Lhe neck
Llssue may become very swollen and ln Lroplcal counLrles Lhe lnfecLlon can occur ln skln ulcers

lL ls malnly spread by dropleLs expelled from Lhe nose and mouLh usually by breaLhlng ln dlphLherla
bacLerla afLer an lnfecLed person has coughed sneezed or even laughed lL can also be spread by
handllng used Llssues or by drlnklng from a glass used by an lnfecLed person

nearly one ouL of every Len people who geL dlphLherla wlll dle from lL MosL cases occur among
unvacclnaLed or lnadequaLely vacclnaLed people

1he bacLerlum produces a Loxln whlch can serlously damage Lhe hearL muscle and Lhe nervous

AfLer Lwo Lo slx weeks Lhe effecLs of Lhe Loxln produced by Lhe bacLerla become apparenL wlLh
severe muscle weakness malnly affecLlng Lhe muscles of Lhe head and neck lnflammaLlon of Lhe
hearL muscle can cause hearL fallure

ueaLh usually occurs elLher from resplraLory fallure hearL fallure or a bulld up of Loxln ln Lhe
nervous sysLem

WheLher or noL Lhe paLlenL dles depends on Lhe severlLy of Lhe lllness Lhelr level of lmmunlLy and
Lhe speed wlLh whlch LreaLmenL ls sLarLed

Cne of Lhe reglons where dlphLherla ls presenL ls easLern Lurope lncludlng 8ussla and Lhe former
sLaLes of Lhe SovleL unlon Cases of have occurred ln llnland LsLonla oland and 8elarus and even
Cermany 8elglum and Lhe uk resulLlng from lmporLed lnfecLlon

1reaLmenL 1hls ls speclallsed and requlres medlcal supervlslon ln hosplLal

revenLlon 1ry Lo avold Loo close conLacL wlLh people ln crowded places when Lravelllng ln endemlc
reglons (parLlcularly klsslng and sharlng boLLles or glasses)

ulphLherla can be prevenLed wlLh a safe and effecLlve vacclne A vacclne ls now avallable for
Lravellers Lo provlde proLecLlon agalnsL boLh dlphLherla and LeLanus

lmmunlsaLlon ls very effecLlve and uk chlldren are lmmunlsed wlLhln Lhelr flrsL year 8oosLers are
requlred every 10 years for Lravellers and Lhose aL rlsk


1hls ls a vlral lnfecLlon LhaL ls acqulred from Lhe sallva of an lnfecLed or rabld anlmal usually a dog
or caL ln mosL cases lnfecLlon resulLs from a blLe buL even a llck on an open cuL or sore may be

SympLoms sLarL wlLh lLchlng and Llngllng aL Lhe slLe of Lhe healed blLe and Lhen rapldly progresses Lo
lnclude headache fever spreadlng paralysls confuslon aggresslon and hydrophobla (fear of waLer)

lL may Lake many weeks or monLhs for sympLoms Lo develop alLhough lL ls usually Lwo Lo elghL
weeks Anlmals may be lnfecLlous for flve days before Lhey develop sympLoms

1reaLmenL 1horoughly cleanse all blLes wlLh soap and waLer and do noL allow Lhe wound Lo be
sLlLched LlmlLed bleedlng should be encouraged Apply alcohol lf posslble

lf avallable human lmmunoglobulln (P8lC) should be glven especlally for blLes Lo Lhe head/face 1he
dlsease can almosL always be prevenLed even afLer exposure lf Lhe vacclne ls admlnlsLered wlLhouL

?ou should Lherefore seek medlcal advlce lmmedlaLely and have a course of 3 ln[ecLlons of urlfled
Chlck Lmbryo Cell vacclne (CLC) or Puman ulplold Cell vacclne (PuCv) 1hls can be dlfflculL Lo
obLaln abroad and lf necessary Lhe 8rlLlsh Lmbassy or consulaLe should be conLacLed for a supply

lf you have had a preexposure course of vacclne you should sLlll have a boosLer course of 2 doses
of vacclne wlLhouL delay

revenLlon never approach or handle anlmals you donL know parLlcularly lf Lhey are acLlng

reexposure lmmunlsaLlon agalnsL rables ls recommended for longsLay Lravellers/resldenLs and
Lhose who lnLend Lo Lravel Lo rural and remoLe areas

ln Lhe evenL of a blLe your bodys responses could be qulckly acLlvaLed by boosLer doses of vacclne
1here are rarely any slde effecLs or dlscomforL from Lhe new Lype of vacclne unllke Lhe old Lypes

1uberculosls (18)

1uberculosls (18) ls caused by a bacLerlum called MycobacLerlum Luberculosls and ls one of Lhe
leadlng causes of all adulL deaLhs worldwlde

1he dlsease ls usually spread Lhrough lnfecLed spuLum buL Lhere ls a form spread Lhrough mllk from
lnfecLed cows

1he bacLerla LhaL cause 18 are lnhaled ln Lhe form of mlcroscoplc dropleLs LhaL come from a person
lnfecLed wlLh 18 When coughlng speaklng or sneezlng small dropleLs are expelled lnLo Lhe alr
whlch qulckly dry ouL buL Lhe bacLerla can remaln alrborne for hours Powever Lhe Luberculosls
bacLerla are kllled when exposed Lo ulLravloleL llghL lncludlng sunllghL

AfLer Lhe Luberculosls bacLerla have been lnhaled Lhey reach Lhe lungs and wlLhln approxlmaLely slx
weeks a small lnfecLlon appears whlch rarely glves any sympLoms buL someLlmes general malalse
weakness and welghL loss are characLerlsLlc durlng Lhe lncubaLlon perlod whlch may be up Lo Lwelve
weeks AfLer Lhls Lhe bacLerla can Lhen spread Lhrough Lhe blood

1he lnfecLlon remalns dormanL ln mosL cases ln people who are oLherwlse healLhy and does noL do
any obvlous harm MonLhs or even years laLer however Lhe dlsease can become reacLlvaLed ln
dlfferenL organs lf Lhe lmmune sysLem ls weakened 1he lungs are Lhe favourlLe place for Lhe lllness
Lo sLrlke

SympLoms of 18 lnclude cough blood ln Lhe spuLum welghL loss faLlgue and nlghL sweaLs 1he
bacLerla can spread Lo Lhe blood ln lndlvlduals who have weak lmmune sysLems (especlally when
caused by alcohol)

18 ls prlmarlly a dlsease of Lhe lungs causlng perslsLenL cough wlLh fever and sweaLlng Powever Lhe
lnfecLlon can spread vla blood from Lhe lungs Lo oLher organs ln Lhe body Lhe bones Lhe urlnary
LracL and sexual organs Lhe lnLesLlnes and even ln Lhe skln Lymph nodes ln Lhe lungs and LhroaL can
also geL lnfecLed

SomeLlmes Lhe dlsease can be overwhelmlng produclng menlnglLls and coma Lhls parLlcularly
dangerous form ls usually found ln chlldren and Lhose who have noL prevlously been vacclnaLed or
exposed Lo Lhe dlsease

1hree mllllon deaLhs occur each year from 18 whlch ls more Lhan any oLher slngle lnfecLlous
dlsease 1he dlsease ls more common ln areas of Lhe world where poverLy malnuLrlLlon poor
general healLh and soclal dlsrupLlon are presenL 1he dlsease has been commonly found ln places of
crowdlng such as hosLels and prlsons where healLhcare ls poor

1reaLmenL 1reaLmenL wlLh ls effecLlve buL ls prolonged lL ls also expenslve and

LffecLlve and affordable anLlmlcroblal drugs Lo LreaL 18 dlsease have been avallable for decades buL
Lhese musL be Laken for slx Lo elghL monLhs under medlcal supervlslon because lf LreaLmenL ls noL
compleLed Lhe emergence of drugreslsLanL sLralns of Lhe 18 bacLerla may be encouraged 1hese
medlclnes may noL always avallable abroad

revenLlon Avold overcrowded places parLlcularly where splLLlng ls common

never drlnk unpasLeurlsed mllk lf ln doubL boll lL before drlnklng

1here ls a vacclnaLlon agalnsL 18 whlch can glve a valuable degree of proLecLlon parLlcularly ln

1hose who have noL recelved 8CC lmmunlsaLlon are advlsed Lo do so and lf for Lravel purposes aL
leasL slx weeks before deparLure Lo ensure a proLecLlve level of lmmunlLy