Control of the diseases caused by Gram negative:

Haemophilus influenzae, Treponema pallidum,

Salmonella typhi, Shigella flexneri, Vibrio cholarea

By: prof. Taksh d vala

Haemophilus influenzae
 Haemophilus influenzae, a type of bacteria, can cause
many different kinds of infections. These infections range
from mild, like ear infections, to serious, like bloodstream
infections.
 The most common types of invasive disease caused
by H. influenzae are:
 Pneumonia* (lung infection)
 Bloodstream infection
 Meningitis (swelling of the lining of the brain and spinal
cord)
 Epiglotittis (swelling in the throat)
 Cellulitis (skin infection)
 Infectious arthritis (inflammation of the joint)
 How it spreads
 People spread H. influenzae, including Hib, to
others through respiratory droplets. People who
are infected spread the bacteria by coughing or
sneezing, which creates small respiratory droplets
that contain the bacteria.
 Other people can get sick if they breathe in those
droplets. People who are not sick but have the
bacteria in their noses and throats can still spread
the bacteria.
 That is how H. influenzae spreads most of the
time. The bacteria can also spread to people who
have close or lengthy contact with a person
with H. influenzae disease.
Signs and Symptoms

Pneumonia
Symptoms of pneumonia usually include:
Fever and chills
Cough
Shortness of breath or difficulty breathing
Sweating
Chest pain
Headache
Muscle pain or aches
Excessive tiredness
 Bloodstream infection
 Symptoms of bloodstream infection usually include:
 Fever and chills
 Excessive tiredness
 Pain in the belly
 Nausea with or without vomiting
 Diarrhea
 Anxiety
 Shortness of breath or difficulty breathing
 Altered mental status (confusion)
 A bloodstream infection from H. influenzae can
occur with or without pneumonia.
 Meningitis
 Symptoms of meningitis typically include sudden onset
of:
 Fever
 Headache
 Stiff neck
 Nausea with or without vomiting
 Photophobia (eyes being more sensitive to light)
 Altered mental status (confusion)
 Babies with meningitis may:
 Be irritable
 Vomit
 Feed poorly
 Appear to be slow or inactive
 Have abnormal reflexes
 Treatment
 People diagnosed with H. influenzae disease take
antibiotics to treat the infection. Depending on how
serious the infection is, people with H.
influenzae disease may need care in a hospital. Other
treatments may include:
 Breathing support
 Medication to treat low blood pressure
 Wound care for parts of the body with damaged skin
 When H. influenzae cause milder infections, like
bronchitis or ear infections, doctors may give
antibiotics to prevent complications.
Learn more about using antibiotics for these infectio
ns
Prevention
 Vaccine
 Vaccines can prevent Haemophilus influenzae type b (Hib)
disease. However, the Hib vaccine does not prevent disease
caused by the other types of H. influenzae.
 Re-infection
 People can get H. influenzae more than once. A previous Hib
infection might not protect you from future infection.
Therefore, CDC recommends Hib vaccination even if
someone has had Hib disease in the past.
 Preventive antibiotics
 H. influenzae can spread to people who have close or lengthy
contact with a person with H. influenzae disease. In certain
cases, close contacts of someone with H. influenzae disease
should receive antibiotics to prevent them from getting sick.
A doctor or local health department will make
recommendations for who should receive preventive
 Treponema pallidum
 The cause of syphilis is a bacterium called Treponema
pallidum. The most common way syphilis spreads is
through contact with an infected person's sore during
vaginal, oral or anal sex.
 The bacteria enter the body through minor cuts or scrapes
in the skin or in the moist inner lining of some body parts.
 Syphilis is contagious during its primary and secondary
stages. Sometimes it's also contagious in the early latent
period, which happens within a year of getting infected.
 Less often, syphilis can spread by kissing or touching an
active sore on the lips, tongue, mouth, breasts or genitals.
It also can be passed to babies during pregnancy and
childbirth and sometimes through breastfeeding.
Syphilis can't be spread through casual
contact with objects that an infected person
has touched.
So you can't catch it by using the same
toilet, bathtub, clothing, eating utensils,
doorknobs, swimming pools or hot tubs.
Once cured, syphilis doesn't come back on
its own. But you can become infected again
if you have contact with someone's syphilis
sore.
 Symptoms
 Syphilis develops in stages. The symptoms vary with each
stage. But the stages may overlap. And the symptoms don't
always happen in the same order. You may be infected with
syphilis bacteria without noticing any symptoms for years.
 Primary syphilis
 The first symptom of syphilis is a small sore called a
chancre (SHANG-kur). The sore is often painless. It
appears at the spot where the bacteria entered your body.
Most people with syphilis develop only one chancre. Some
people get more than one.
 The chancre often forms about three weeks after you come
in contact with syphilis bacteria. Many people who have
syphilis don't notice the chancre. That's because it's usually
painless. It also may be hidden within the vagina or rectum.
The chancre heals on its own within 3 to 6 weeks.
Secondary syphilis
 You may get a rash while the first chancre heals
or a few weeks after it heals.
 A rash caused by syphilis:
 Often is not itchy.
 May look rough, red or reddish-brown.
 Might be so faint that it's hard to see.
 The rash often starts on the trunk of the body.
That includes the chest, stomach area, pelvis
and back. In time, it also could appear on the
limbs, the palms of the hands and the soles of
the feet.
Along with the rash, you may have symptoms such
as:
 Wartlike sores in the mouth or genital area.
 Hair loss.
 Muscle aches.
 Fever.
 Sore throat.
 Tiredness, also called fatigue.
 Weight loss.
 Swollen lymph nodes.
 Symptoms of secondary syphilis may go away on their
own. But without treatment, they could come and go
for months or years.
Latent syphilis
If you aren't treated for syphilis, the
disease moves from the secondary stage
to the latent stage.
This also is called the hidden stage
because you have no symptoms. The
latent stage can last for years. Your
symptoms may never come back.
But without treatment, the disease might
lead to major health problems, also called
complications.
 Tertiary syphilis
 After the latent stage, up to 30% to 40% of people with
syphilis who don't get treatment have complications known
as tertiary syphilis. Another name for it is late syphilis.
 The disease may damage the:
 Brain.
 Nerves.
 Eyes.
 Heart.
 Blood vessels.
 Liver.
 Bones and joints.
 These problems may happen many years after the original,
untreated infection.
 Congenital syphilis
 Pregnant people who have syphilis can pass the disease to
their babies. Unborn babies can become infected through
the organ that provides nutrients and oxygen in the womb,
called the placenta. Infection also can happen during birth.
 Newborns with congenital syphilis might have no
symptoms. But without fast treatment, some babies might
get:
 Sores and rashes on the skin.
 Fever.
 A type of discolored skin and eyes, called jaundice.
 Not enough red blood cells, called anemia.
 Swollen spleen and liver.
 Sneezing or stuffed, drippy nose, called rhinitis.
 Bone changes.
Prevention
 There is no vaccine for syphilis. To help prevent the
spread of syphilis, follow these tips:
 Have safe sex or no sex. The only certain way to avoid
contact with syphilis bacteria is not to have sex. This is
called abstinence. If a person is sexually active, safer
sex means a long-term relationship in which you and
your partner have sex only with each other, and neither
of you is infected. Before you have sex with someone
new, you should both get tested for syphilis and other
sexually transmitted infections (STIs).
 Use a latex condom. Condoms can lower your risk of
getting or spreading syphilis. But condoms work only if
they cover an infected person's syphilis sores. Other
types of birth control do not lower your risk of syphilis.
 Be careful with alcohol and stay away from street
drugs. Drinking too much alcohol or taking drugs can
get in the way of your judgment. Either can lead to
unsafe sex.
 Do not douche. It can remove some of the healthy
bacteria that's usually in the vagina. And that might
raise your risk of getting STIs.
 Breastfeed with caution. Syphilis can pass from a
parent to a baby during breastfeeding if sores are on
one or both breasts. This can happen when the baby or
pumping equipment touches a sore. To keep that from
happening, pump or hand-express breastmilk from the
breast with sores. Do so until the sores heal. If your
pump touches a sore, get rid of the milk you just
pumped.
Salmonella typhi
 Typhoid fever, also called enteric fever, is caused by salmonella
bacteria. Typhoid fever is rare in places where few people carry the
bacteria. It also is rare where water is treated to kill germs and where
human waste disposal is managed. One example of where typhoid
fever is rare is the United States. Places with the highest number of
cases or with regular outbreaks are in Africa and South Asia. It is a
serious health threat, especially for children, in places where it is
more common.
 Food and water with the bacteria in it cause typhoid fever. Close
contact with a person who is carrying the salmonella bacteria also
can cause typhoid fever. Symptoms include:
 High fever.
 Headache.
 Stomach pain.
 Constipation or diarrhea.
Most people who have typhoid fever feel
better about a week after they start treatment
to kill bacteria, called antibiotics.
But without treatment, there is a small chance
of death from typhoid fever complications.
Vaccines against typhoid fever can provide
some protection. But they can't protect
against all cases of illness caused by other
strains of salmonella.
Vaccines can help lower risk of getting
typhoid fever.
Symptoms
 Symptoms are likely to start slowly, often showing up 1 to 3
weeks after exposure to the bacteria.
 Early illness
 Early symptoms include:
 Fever that starts low and increases throughout the day, possibly
reaching as high as 104 degrees Fahrenheit (40 degrees
Celsius).
 Chills.
 Headache.
 Weakness and fatigue.
 Muscle aches.
 Stomach pain.
 Diarrhea or constipation.
 Rash.
 People also may have a cough, loss of appetite and sweating.
 Later illness
 A few weeks after symptoms start, the illness can cause
problems in the intestines. People may have:
 Stomach pain.
 Very swollen stomach.
 An infection caused by gut bacteria spreading throughout
the body, called sepsis.
 In very serious cases, people may:
 Become confused.
 Not be able to pay attention to anything around them.
 Not be able to react to the world around them.
 These are life-threatening complications.
 In some people, symptoms may return up to a few weeks
after the fever has gone away.
Prevention
People can get a vaccination against typhoid
fever. This is an option if you live where typhoid
fever is common.
It is also an option if you plan to travel to a place
where the risk is high.
Where typhoid fever is common, access to treated
water helps avoid contact with the Salmonella
enterica serotype typhi bacteria. Management of
human waste also helps people avoid the bacteria.
And careful hand-washing for people who
prepare and serve food is also important.
Vaccines
Two vaccines are available in the United States for
people age 2 and older.
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.
The effectiveness of these vaccines wears off over time.
So repeat immunization is needed.
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
 Avoid using untreated water. Contaminated drinking
water is a problem in areas where typhoid fever is
common. For that reason, drink only bottled water or
canned or bottled carbonated beverages, wine and beer.
Carbonated bottled water is safer than noncarbonated
bottled water. Ask for drinks without ice. Use bottled water
to brush your teeth, and try not to swallow water in the
shower.
 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
safe, you may want to avoid raw foods.
 Choose hot foods. Avoid food that's stored or served at
room temperature. Freshly made, steaming hot foods may
be less risky than uncooked foods.
 Know where the health care providers are. Find out
about medical care in the areas you'll visit. Carry a list of
the names, addresses and phone numbers of health care
 Shigella flexneri
 Shigella infection (shigellosis) is an intestinal infection
caused by a family of bacteria known as shigella. The main
sign of shigella infection is diarrhea, which often is bloody.
 Shigella is very contagious. People get infected with
shigella when they come in contact with and swallow small
amounts of bacteria from the stool of a person who is
infected with shigella. For example, this can happen in a
child care setting when staff members don't wash their
hands well enough after changing diapers or helping
toddlers with toilet training. Shigella bacteria can also be
passed in infected food or by drinking or swimming in
unsafe water.
 Children under age 5 are most likely to get shigella
infection, but it can occur at any age. A mild case usually
clears up on its own within a week. When treatment is
needed, doctors generally prescribe antibiotics.
Symptoms
 Signs and symptoms of shigella infection usually begin
a day or two after contact with shigella. But it may take
up to a week to develop. Signs and symptoms may
include:
 Diarrhea (often containing blood or mucus)
 Stomach pain or cramps
 Fever
 Nausea or vomiting
 Symptoms generally last for about five to seven days. In
some cases, symptoms may last longer. Some people
have no symptoms after they've been infected with
shigella. However, their feces may still be contagious up
to a few weeks.
Causes
 Infection occurs when you accidentally swallow shigella
bacteria. This can happen when you:
 Touch your mouth. Direct person-to-person contact is
the most common way the disease is spread. For
example, if you don't wash your hands well after
changing the diaper of a child who has shigella
infection, you may become infected yourself.
 Eat contaminated food. Infected people who handle
food can spread the bacteria to people who eat the food.
Food can also become infected with shigella bacteria if
it grows in a field that contains sewage.
 Swallow contaminated water. Water may become
infected with shigella bacteria either from sewage or
from a person with shigella infection swimming in it.
Complications

 Shigella infection usually clears up without complications. But it may

take weeks or months before your bowel habits return to normal.
 Complications may include:
 Dehydration. Constant diarrhea can cause dehydration. Signs and
symptoms include lightheadedness, dizziness, lack of tears in
children, sunken eyes and dry diapers. Severe dehydration can lead to
shock and death.
 Seizures. Some children with a shigella infection have seizures.
Seizures are more common in children who run a high fever, but can
occur in children who do not have a high fever. It's not known
whether the seizures are a result of the fever or the shigella infection
itself. If your child has a seizure, contact your doctor immediately.
 Rectal prolapse. In this condition, straining during bowel movements
or inflammation of the large intestine may cause the mucous
membrane or lining of the rectum to move out through the anus.
 Hemolytic uremic syndrome. This rare complication of shigella,
more commonly caused by a type of E. coli bacteria than by
shigella bacteria, can lead to a low red blood cell count (hemolytic
anemia), low platelet count (thrombocytopenia) and acute kidney
failure.
 Toxic megacolon. This rare complication occurs when your colon
becomes paralyzed, preventing you from having a bowel movement
or passing gas. Signs and symptoms include stomach pain and
swelling, fever and weakness. If you don't receive treatment for
toxic megacolon, your colon may break open (rupture), causing
peritonitis, a life-threatening infection requiring emergency surgery.
 Reactive arthritis. Reactive arthritis develops in response to an
infection. Signs and symptoms include joint pain and inflammation,
usually in the ankles, knees, feet and hips; redness, itching and
discharge in one or both eyes (conjunctivitis); and painful urination
(urethritis).
 Bloodstream infections (bacteremia). Shigella infection can
damage the lining of the intestines. In rare cases, shigella bacteria
can enter the bloodstream through the damaged intestinal lining and
cause a bloodstream infection.
Prevention
 Although researchers continue to work to develop a shigella
vaccine, nothing is available yet. To prevent the spread of
shigella:
 Wash hands with soap and water for at least 20 seconds
frequently
 Watch small children when they wash their hands
 Throw away soiled diapers properly
 Disinfect diaper-changing areas after use
 Don't prepare food for others if you have diarrhea
 Keep children with diarrhea home from child care, play groups
or school
 Avoid swallowing water from ponds, lakes or untreated pools
 Avoid sexual activity with anyone who has diarrhea or who
recently recovered from diarrhea
 Don't go swimming until you have fully recovered.
Vibrio cholarea
 A bacterium called Vibrio cholerae causes cholera
infection. The deadly effects of the disease are the result of
a toxin the bacteria produces in the small intestine. The
toxin causes the body to secrete enormous amounts of
water, leading to diarrhea and a rapid loss of fluids and
salts (electrolytes).
 Cholera bacteria might not cause illness in all people who
are exposed to them, but they still pass the bacteria in their
stool, which can contaminate food and water supplies.
 Contaminated water supplies are the main source of
cholera infection. The bacterium can be found in:
 Surface or well water. Contaminated public wells are
frequent sources of large-scale cholera outbreaks. People
living in crowded conditions without adequate sanitation
are especially at risk.
 Seafood. Eating raw or undercooked seafood, especially
shellfish, that comes from certain places can expose you
to cholera bacteria. Most recent cases of cholera in the
United States have been traced to seafood from the Gulf
of Mexico.
 Raw fruits and vegetables. Raw, unpeeled fruits and
vegetables are a frequent source of cholera infection in
areas where there's cholera.
 In developing countries, uncomposted manure fertilizers
or irrigation water containing raw sewage can
contaminate produce in the field.
 Grains. In regions where cholera is widespread, grains
such as rice and millet that are contaminated after cooking
and kept at room temperature for several hours can grow
cholera bacteria.
 Symptoms of cholera infection can include:

 Diarrhea. Cholera-related diarrhea comes on suddenly and

can quickly cause dangerous fluid loss — as much as a
quart (about 1 liter) an hour. Diarrhea due to cholera often
has a pale, milky appearance that resembles water in which
rice has been rinsed.
 Nausea and vomiting. Vomiting occurs especially in the
early stages of cholera and can last for hours.
 Dehydration. Dehydration can develop within hours after
cholera symptoms start and range from mild to severe. A
loss of 10% or more of body weight indicates severe
dehydration.
 Signs and symptoms of cholera dehydration include
irritability, fatigue, sunken eyes, a dry mouth, extreme
thirst, dry and shriveled skin that's slow to bounce back
when pinched into a fold, little or no urinating, low blood
 Dehydration can lead to a rapid loss of minerals in
your blood that maintain the balance of fluids in
your body. This is called an electrolyte imbalance.
 Electrolyte imbalance
 An electrolyte imbalance can lead to serious signs
and symptoms such as:
 Muscle cramps. These result from the rapid loss of
salts such as sodium, chloride and potassium.
 Shock. This is one of the most serious complications
of dehydration. It occurs when low blood volume
causes a drop in blood pressure and a drop in the
amount of oxygen in your body. If untreated, severe
hypovolemic shock can cause death in minutes.
Complications
 Although shock and severe dehydration are the worst
complications of cholera, other problems can occur, such as:
 Low blood sugar (hypoglycemia). Dangerously low levels
of blood sugar (glucose) — the body's main energy source
— can occur when people become too ill to eat. Children
are at greatest risk of this complication, which can cause
seizures, unconsciousness and even death.
 Low potassium levels. People with cholera lose large
quantities of minerals, including potassium, in their stools.
Very low potassium levels interfere with heart and nerve
function and are life-threatening.
 Kidney failure. When the kidneys lose their filtering ability,
excess amounts of fluids, some electrolytes and wastes build
up in the body — a potentially life-threatening condition. In
peopl
Prevention
 Cholera is rare in the United States with the few cases related
to travel outside the U.S. or to contaminated and improperly
cooked seafood from the Gulf Coast waters.
 If you're traveling to areas known to have cholera, your risk of
contracting the disease is extremely low if you follow these
precautions:
 Wash your hands with soap and water frequently, especially
after using the toilet and before handling food. Rub soapy, wet
hands together for at least 15 seconds before rinsing. If soap
and water aren't available, use an alcohol-based hand sanitizer.
 Drink only safe water, including bottled water or water you've
boiled or disinfected yourself. Use bottled water even to brush
your teeth.
 Hot beverages are generally safe, as are canned or bottled
drinks, but wipe the outside before you open them. Don't add
ice to your drinks unless you made it yourself using safe water.
 Eat food that's completely cooked and hot and avoid street
vendor food, if possible. If you do buy a meal from a street
vendor, make sure it's cooked in your presence and served hot.
 Avoid sushi, as well as raw or improperly cooked fish and
seafood of any kind.
 Stick to fruits and vegetables that you can peel
yourself, such as bananas, oranges and avocados. Stay away
from salads and fruits that can't be peeled, such as grapes and
berries.
 Cholera vaccine
 People traveling from the United States to areas affected by
cholera can get a cholera vaccine called Vaxchora. It's
suggested for people between ages 2 and 64 who plan to travel
where cholera is being spread or regularly spreads. It is a liquid
dose taken by mouth at least 10 days before travel.
 Several other countries offer oral vaccines as well. Contact your
doctor or local office of public health for more information
about these vaccines. Even with the vaccine, it's important to
take the above precautions to prevent cholera.