COURSE TITTLE: IMMUNOLOGY/INFECTIOUS DISEASE

COURSE CODE: NUS214

SEMESTER: First Semester

INSTRUCTOR: Mme Chung/ Kwandze

Introduction

Infectious diseases are disorders caused by organisms such as bacteria, viruses, fungi or
parasites. Many organisms live in and on our bodies. They're normally harmless or even helpful,
but under certain conditions, some organisms may cause disease.

Some infectious diseases can be passed from person to person. Some are transmitted by bites
from insects or animals. And others are acquired by ingesting contaminated food or water or
being exposed to organisms in the environment.

Signs and symptoms vary depending on the organism causing the infection, but often include
fever and fatigue. Mild infections may respond to rest and home remedies, while some life-
threatening infections may require hospitalization.

Many infectious diseases, such as measles and chickenpox, can be prevented by vaccines.
Frequent and thorough hand-washing also helps protect us from most infectious diseases.

Each infectious disease has its own specific signs and symptoms. General signs and symptoms
common to a number of infectious diseases include:

 Fever
 Diarrhea
 Fatigue
 Muscle aches
 Coughing

Infectious diseases can be caused by:

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  Bacteria. These one-cell organisms are responsible for illnesses such as strep throat,
urinary tract infections and tuberculosis.
 Viruses. Even smaller than bacteria, viruses cause a multitude of diseases ranging from
the common cold to AIDS.
 Fungi. Many skin diseases, such as ringworm and athlete's foot, are caused by fungi.
Other types of fungi can infect the lungs or nervous system.
 Parasites. Malaria is caused by a tiny parasite that is transmitted by a mosquito bite.
Other parasites may be transmitted to humans from animal feces.
 Helminthes: worms and flukes

Method of disease transmission

Direct contact

An easy way to contract most infectious diseases is by coming in contact with a person or animal
that has the infection. Three ways infectious diseases can be spread through direct contact are:

 Person to person. A common way for infectious diseases to spread is through the direct
transfer of bacteria, viruses or other germs from one person to another. This can occur
when an individual with the bacterium or virus touches, kisses, or coughs or sneezes on
someone who isn't infected.

These germs can also spread through the exchange of body fluids from sexual contact.
The person who passes the germ may have no symptoms of the disease, but may simply
be a carrier.

 Animal to person. Being bitten or scratched by an infected animal even a pet can make
you sick and, in extreme circumstances, can be fatal. Handling animal waste can be
hazardous, too. For example, you can acquire a toxoplasmosis infection by scooping your
cat's litter box.
 Mother to unborn child. A pregnant woman may pass germs that cause infectious
diseases to her unborn baby. Some germs can pass through the placenta. Germs in the
vagina can be transmitted to the baby during birth.

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Indirect Contact

Disease-causing organisms also can be passed by indirect contact. Many germs can linger on an
inanimate object, such as a tabletop, doorknob or faucet handle.

When you touch a doorknob handled by someone ill with the flu or a cold, for example, you can
pick up the germs he or she left behind. If you then touch your eyes, mouth or nose before
washing your hands, you may become infected.

Insect Bites

Some germs rely on insect carriers such as mosquitoes, fleas, lice or ticks — to move from host
to host. These carriers are known as vectors. Mosquitoes can carry the malaria parasite or West
Nile virus, and deer ticks may carry the bacterium that causes Lyme disease.

Food Contamination

Another way disease-causing germs can infect you is through contaminated food and water. This
mechanism of transmission allows germs to be spread to many people through a single source. E.
coli, for example, is a bacterium present in or on certain foods — such as undercooked
hamburger or unpasteurized fruit juice.

Risk Factors

While anyone can catch infectious diseases, you may be more likely to get sick if your immune
system isn't working properly. This may occur if:

 You're taking steroids or other medications that suppress your immune system, such as
anti-rejection drugs for a transplanted organ
 You have HIV or AIDS
 You have certain types of cancer or other disorders that affect your immune system

In addition, certain other medical conditions may predispose you to infection, including
implanted medical devices, malnutrition and extremes of age, among others.

Prevention
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Infectious agents can enter the body through:

 Skin contact or injuries

 Inhalation of airborne germs
 Ingestion of contaminated food or water
 Tick or mosquito bites
 Sexual contact

Follow these tips to decrease your risk of infecting yourself or others:

 Wash your hands. This is especially important before and after preparing food, before
eating, and after using the toilet. And try not to touch your eyes, nose or mouth with your
hands, as that's a common way germs enter the body.
 Get vaccinated. Immunization can drastically reduce the chances of contracting many
diseases. Keep up to date on the recommended vaccinations, as well as your children's.
 Stay home when ill. Don't go to work if you are vomiting, have diarrhea or have a fever.
Don't send your child to school if he or she has these signs and symptoms, either.
 Prepare food safely. Keep counters and other kitchen surfaces clean when preparing
meals. Cook foods to the proper temperature using a food thermometer to check for
doneness. For ground meats, that means at least 160 F (71 C); for poultry, 165 F (74 C);
and for most other meat, at least 145 F (63 C).

In addition, promptly refrigerate leftovers don't let cooked foods remain at room
temperature for extended periods of time.

 Practice safe sex. Always use condoms if you or your partner has a history of sexually
transmitted infections or high-risk behavior.
 Don't share personal items. Use your own toothbrush, comb and razor. Avoid sharing
drinking glasses or dining utensils.
 Travel wisely. If you're traveling out of the country, talk to your doctor about any special
vaccinations such as yellow fever, cholera, hepatitis A or B, or typhoid fever you may
need.

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Chain of infection

In order for infection to occur several things have to happen. This is often referred to as the
Chain of Infection. The six links in the chain are:

1. The Infectious Agent – or the microorganism which has the ability to cause disease.
2. The Reservoir or source of infection where the microorganism can live and thrive. This
may be a person, an animal, any object in the general environment, food or water.
3. The Portal of Exit from the reservoir. This describes the way the microorganism leaves
the reservoir. For example, in the case of a person with flu, this would include coughing
and sneezing. In the case of someone with gastro-enteritis microorganisms would be
transmitted in the faeces or vomit.
4. The Mode of Transmission. This describes how microorganisms are transmitted from
one person or place to another. This could be via someone‘s hands, on an object, through
the air or bodily fluid contact.
5. The Portal of Entry. This is how the infection enters another individual. This could be
landing on a mucous membrane, being breathed in, entering via a wound, or a tube such
as a catheter.
6. The Susceptible Host. This describes the person who is vulnerable to infection.

Infection can be prevented by breaking the Chain of Infection.

The chain of infection diagram illustrates and gives examples of actions that can be taken to
break it. The overall aim of Standard Infection Control Precautions is to break the Chain.

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Links in the chain
• Disease Microorganisms (Agent). These are the pathogens that cause communicable diseases.
Most commonly these are bacteria, virus, fungi or parasites.
• Reservoir. The reservoir (source) is a host which allows the pathogen to live, and possibly
grow, and multiply. Humans, animals and the environment can all be reservoirs for
microorganisms. Sometimes a person may have a disease but is not symptomatic or ill. This type
of person is a carrier and she/he may be referred to as colonized‘. Examples of reservoirs are
standing water, a person with a common cold or syphilis, or a dog with rabies.
• Mode of Escape. This refers to the route by which the infectious

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microorganisms escape or leave the reservoir. For example, pathogens that cause respiratory
diseases usually escape through the respiratory tract (coughing and sneezing).

Modes of Escape of infections and Breaking the Link

Respiratory Tract.

Microorganisms leave the body of the infected person by means of

droplets exhaled as a spray when coughing, sneezing, talking, singing or just breathing.
Microorganisms also escape through nose
and throat secretions. To break the link, the following can be done:
• Wear a mask
• Do not talk directly into patient‘s face
• Stay home if you are sick
• Practice good cough etiquette (cover your coughs and sneezes)
• Perform good hand hygiene
Gastrointestinal Tract.

Microorganisms that leave the body of the infected person

by means of body secretions (e.g. stool and vomit). For example hepatitis A virus is shed in the
stool of the infected person.

Link can be broken by:

• Handle and dispose of body secretions
properly
• Use personal protective equipment
• Perform good housekeeping
• Perform good hand hygiene
Skin.

Microorganisms that leave the body of the infected person by wound drainage or through skin
lesions. Link can be broken by:
• Dispose of wound dressings properly
• Use personal protective equipment (PPE)

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• Perform good hand hygiene
Blood.

Infection may occur when someone‘s blood gets into another person‘s system. Link can be
broken by:
• Safe handling of sharps
• Use gloves for procedures where there is risk of exposure to blood
• Use care in obtaining, transporting and processing specimens
• Perform good hand hygiene
Pathogens enter the body by:
• inhalation (e.g. respiratory tract)
• ingestion (e.g .GI tract)
• absorption (e.g. mucous membranes of eyes)
• break in skin (e.g. needle stick, cut)
• introduction by medical procedures (e.g. catheters)
Susceptible Host. The future host is the person who is next exposed to the pathogen. The
microorganism may spread to another person but does not develop into an infection if the
person‘s immune system can fight it off. They may however become a ‗carrier‘ without
symptoms, able to then be the next ‗mode of transmission‘ to another ‗susceptible host‘. Once
the host is infected, he/she may become a reservoir for future transmission of the disease.
Susceptible hosts abound in health care settings, as those accessing the health care system often
have compromised immune systems. This may be due to other illnesses processes, treatments or
medications. This ineffective immune system leaves them vulnerable to infectious agents that
may be in the health care environment.
Susceptible and Hosts Control
• Children who are very young
• People who are very old
• People on inadequate diets
• People who are chronically ill
• People receiving medical therapy such as chemotherapy or high doses of steroids
• People who are already ill

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• People with open wounds
Control can be done by:
Separate high risk individuals from persons with known or potential infections
• Provide nutritional supplements to persons
on inadequate diets
• Vaccinate against vaccine preventable
diseases
• Maintain proper sanitation of air and
environment
• Diagnose and treat underlying disease
Opportunities to break the chain of infection
Transmission may be interrupted when:
• the infectious agent is eliminated, inactivated or cannot exit the reservoir
• the portals of exit are contained through safe infection control practices
• the transmission between objects or people does not occur due to barriers and safe infection
control practices
• the portals of entry are protected
• other persons receiving health care are not susceptible.
Phases of Infectious Disease

 Incubation period – time between infection and the appearance of signs and symptoms.

 Prodromal phase – mild, nonspecific symptoms that signal onset of some diseases.

 Clinical phase – a person experiences typical signs and symptoms of disease.

 Decline phase - subsidence of symptoms.

 Recovery phase – symptoms have disappeared, tissues heal, and the body regains
strength.

Classification of Infectious Disease

 By duration

o Acute – develops and runs its course quickly.

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 o Chronic – develops more slowly and is usually less severe, but may persist for a
long, indefinite period of time.

o Latent – characterized by periods of no symptoms between outbreaks of illness.

 By location

o Local – confined to a specific area of the body.

o Systemic – a generalized illness that infects most of the body with pathogens
distributed widely in tissues.

 By timing

o Primary – initial infection in a previously healthy person.

o Secondary – infection that occurs in a person weakened by a primary infection.

The epidemiological triangle (triad)

The Epidemiologic Triangle is a model used when investigating the spread of disease and how to
combat it. It can help students understand infectious diseases and how they spread and facts.
The Triangle has three corners (called vertices):
Agent, or microbe that causes the disease, (the ―what‖ of the Triangle)
Host, or organism harboring the disease, (the ―who‖ of the Triangle)
Environment, or those external factors that cause or allow disease transmission (the ―where‖ of
the Triangle

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Important terminology in infectious diseases

An outbreak

Sudden occurrence of a disease than expected in a particular area or season. The area could be a
small community or extend to several areas. An outbreak could even be a single case of a disease
caused by a significant pathogen new to a community or one not seen for a long time ( e.g
diphtheria). An outbreak can last for a few days, weeks or even several years.

Endemic

An endemic is an outbreak that occurs at a predictable rate in a certain area or among a set
population. Endemics remain at a steady state, but do not disappear from a population. There is a
high level of the disease all the time. E.g malaria

Epidemic

An epidemic will see a disease rapidly spread among a large number of people in a given
population. During an epidemic the disease will normally spread in two weeks or less.

N.B The definition of epidemic is very similar to the definition of an outbreak. In fact, some
health organizations have the same definition for outbreak AND epidemic. However, ‗outbreak‘
is usually used when diseases happen in a more limited geographic area. If an outbreak of a
diseases spreads quickly to more people than experts would expect and moves into a large
geographic area, it is often then called an epidemic.

A pandemic

A pandemic is the worldwide spread of a new infectious disease. The word is from the Greek
'pan' meaning 'all' and 'demos' meaning ‗people'. It stretches over a larger area, infects more
people and causes more deaths than an epidemic. But the term refers to the spread of disease, not
its potency or deadliness. The World Health Organization (WHO) defines a pandemic as "an
outbreak of a new pathogen that spreads easily from person to person across the globe".

Emerging infectious diseases

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These are infections that have recently appeared within a population due to spread of infectious
agent to a new host, new location, due to the appearance of a new infectious agent or previously
unknown agent.

TYPHOID & PARATYPHOID FEVER

Salmonella enterica serotypes Typhi and Paratyphi A, Paratyphi B (tartrate negative), and
Paratyphi C cause a potentially severe and occasionally life-threatening bacteremic illness
referred to respectively as typhoid and paratyphoid fever, and collectively as enteric fever.

Transmission

Typhoid and paratyphoid fever are most often acquired through consumption of water or food
that has been contaminated by feces of an acutely infected or convalescent person or a chronic,
asymptomatic carrier. Transmission through sexual contact, especially among men who have sex
with men, has been documented rarely.

Clinical Presentation

The incubation period of typhoid and paratyphoid infections is 6–30 days. The onset of illness is
insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to as
high as 102°F–104°F (38°C–40°C) by the third to fourth day of illness. Headache, malaise, and
anorexia are nearly universal, and abdominal pain, diarrhea, or constipation is common.
Hepatosplenomegaly can often be detected. A transient, macular rash of rose-colored spots can
occasionally be seen on the trunk. Fever is commonly lowest in the morning, reaching a peak in
late afternoon or evening. This clinical presentation is often confused with malaria, and typhoid
fever should be suspected in a person with a history of travel to an endemic area who is not
responding to anti-malarial medication. Untreated, the disease can last for a month. The serious
complications of typhoid fever generally occur after 2–3 weeks of illness and may include life-
threatening intestinal hemorrhage or perforation.

Diagnosis

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Blood culture is the mainstay of diagnosis in typhoid and paratyphoid fever. Bone marrow
culture increases the diagnostic yield to approximately 80% of cases and is relatively unaffected
by prior or concurrent antibiotic use. Stool culture is not usually positive during the first week of
illness, so blood culture is preferred. Urine culture has no higher diagnostic yield than stool
culture for acute cases.

The Widal test is unreliable but is widely used in developing countries because of its low cost. It
is a serologic assay that may react in patients with typhoid or paratyphoid fever, but is not
specific and false positives may occur. Serologic assays are not an adequate substitute for blood,
stool, or bone marrow culture.

Because there is no definitive serologic test for typhoid or paratyphoid fever, the initial diagnosis
often has to be made clinically. The combination of a history of risk for infection and a gradual
onset of fever that increases in severity over several days should raise suspicion of typhoid or
paratyphoid fever. Typhoid fever is a nationally notifiable disease.

Treatment

Specific antimicrobial therapy shortens the clinical course of enteric fever and reduces the risk
for death. Fluoroquinolones are recommended for empiric treatment of enteric fever in adults,
but quinolone resistance is >80% for Typhi and Paratyphi A. Inject able third-generation
cephalosporins are often the empiric drug of choice when the possibility of fluoroquinolone
resistance is high. Azithromycin and ceftriaxone are increasingly used to treat typhoid fever or
paratyphoid fever because of the emergence of multidrug-resistant strains. In contrast, no cases
of ceftriaxone resistance have been reported among Typhi and Paratyphi .

Patients treated with an antibiotic may continue to have fever for 3–5 days, although the height
of the fever generally decreases each day. Patients may actually feel worse during the several
days it takes for the fever to end. If fever in a person with culture-confirmed typhoid or
paratyphoid fever does not subside within 5 days, alternative antimicrobial agents or other foci of
infection such as abscesses, bone or joint infections, and other extra intestinal sites should be
considered.

Prevention
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Food and Water

Safe food and water precautions and frequent hand washing (especially before meals) are
important in preventing typhoid and paratyphoid fever. Although vaccines are recommended to
prevent typhoid fever, they are not 100% effective; therefore, even vaccinated travelers should
follow recommended food and water precautions. For paratyphoid fever, food and water
precautions are the only prevention method, as no vaccines are available.

Vaccine

Indications for Use

CDC recommends typhoid vaccine for travelers to areas where there is an increased risk of
exposure to S. enterica serotype Typhi

Two typhoid vaccines are

Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi, manufactured by Sanofi Pasteur) for
intramuscular use

 Oral live attenuated vaccine (Vivotif, manufactured from the Ty21a strain of
serotypeTyphi by PaxVax)

Both typhoid vaccines protect 50%–80% of recipients; travelers should be reminded that typhoid
immunization is not 100% effective, and typhoid fever could still occur. Available typhoid
vaccines offer no protection against paratyphoid fever.

Vaccine Safety and Adverse Reactions

Adverse reactions to Oral live attenuated vaccine are rare and mainly consist of abdominal
discomfort, nausea, vomiting, and rash. ViCPS vaccine is most often associated with headache
(16%–20%) and injection-site reactions (7%).

MALARIA

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Malaria is a life-threatening disease spread to humans by some types of mosquitoes. It is mostly
found in tropical countries. It is preventable and curable.

The infection is caused by a parasite and does not spread from person to person.

Symptoms can be mild or life-threatening. Mild symptoms are fever, chills and headache. Severe
symptoms include fatigue, confusion, seizures, and difficulty breathing.

Infants, children under 5 years, pregnant women, travelers and people with HIV or AIDS are at
higher risk of severe infection.

Malaria can be prevented by avoiding mosquito bites and with medicines. Treatments can stop
mild cases from getting worse.

Malaria mostly spreads to people through the bites of some infected female Anopheles
mosquitoes. Blood transfusion and contaminated needles may also transmit malaria. The first
symptoms may be mild, similar to many febrile illnesses, and difficulty to recognize as malaria.
Left untreated, P. falciparum malaria can progress to severe illness and death within 24 hours.

There are 5 Plasmodium parasite species that cause malaria in humans and 2 of these species – P.
falciparum and P. vivax – pose the greatest threat. P. falciparum is the deadliest malaria parasite
and the most prevalent on the African continent. P. vivax is the dominant malaria parasite in
most countries outside of sub-Saharan Africa. The other malaria species which can infect
humans are P. malariae, P. ovale and P. knowlesi.

Multiple medicines are used to prevent and treat malaria. Doctors will choose one or more based
on: the type of malaria, whether a malaria parasite is resistant to a medicine, the weight or age of
the person infected with malaria, whether the person is pregnant.

These are the most common medicines for malaria:

 Artemisinin-based combination therapy medicines are the most effective treatment for P.
falciparum malaria.
 Chloroquine is recommended for treatment of infection with the P. vivax parasite only in
places where it is still sensitive to this medicine.
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  Primaquine should be added to the main treatment to prevent relapses of infection with
the P. vivax and P. ovale parasites.

Malaria deaths are usually related to one or more serious complications, including:

Cerebral malaria. If parasite-filled blood cells block small blood vessels to the brain (cerebral
malaria), swelling of the brain or brain damage may occur. Cerebral malaria may cause
confusion, seizures and coma.

Breathing problems. Accumulated fluid in the lungs (pulmonary edema) can make it difficult to
breathe.

Organ failure. Malaria can damage the kidneys or liver or cause the spleen to rupture. Any of
these conditions can be life-threatening.

Anemia. Malaria may result in not having enough red blood cells for an adequate supply of
oxygen to the body's tissues (anemia).

Low blood sugar. Severe forms of malaria can cause low blood sugar (hypoglycemia), as can
quinine — a common medication used to combat malaria. Very low blood sugar can result in
coma or death.

Urinary/ reproductive system and other sexually transmitted infections

Overview of urinary and reproductive system infections:

Urinary Tract Infections (UTIs) are a common type of infection that can affect any part of the
urinary system, including the kidneys, ureters, bladder, and urethra. Types of UTIs are: Lower
urinary tract infections (LUTIs): these occur in the bladder and urethra and are more common in
women. Upper urinary tract infections (UTIs): occur in the kidneys and are more common in
men. Pyelonephritis: is a type of UTI that occurs in the kidneys and can be severe. Urethritis:
This is a type of UTI that occurs in the urethra and can be painful.

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Causes: The most common cause of UTIs is bacteria, specifically Escherichia coli (E. coli),
which is found in the intestines and can enter the urinary tract through the urethra. Viruses (e.g
herpes simplex), fungi (candida)

Symptoms: painful urination, frequent urination, blood in urine, fever, flank pain

Risk factors: female sex, pregnancy, catheter use, urinary tract abnormalities, weakened
immune system, such as in people with diabetes or those taking immunosuppressive medications,
can increase the risk of UTIs.

Treatment: Antibiotics are the primary treatment for UTIs and can help clear the infection.
Drinking plenty of fluids can help flush out the bacteria and promote healing and pain relievers,
such as ibuprofen or acetaminophen, can help alleviate pain and discomfort. Getting plenty of
rest can also help the body recover from the UTI.

Diagnosis of UTIs:

. Urinalysis: A urinalysis test can detect the presence of bacteria or other signs of infection in
urine.

. Urinary tract imaging: Imaging tests, such as X-rays or ultrasound, can help diagnose UTIs
by showing abnormalities in the urinary tract.

. Blood tests: Blood tests can help diagnose UTIs by detecting the presence of bacteria or other
signs of infection in the blood.

Treatment: antibiotics (e.g. ciprofloxacin, trimethoprim-sulfamethoxazole), pain relief, rest,

drinking adequate amounts of water

Prevention

 Practice safe sex: use condoms, get tested for STIs

 Maintain good hygiene: wipe from front to back, avoid douching
 Stay hydrated: drink plenty of water to prevent UTIs
 Get vaccinated: HPV vaccine, pneumococcal conjugate vaccine (PCV)

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Complications

 Kidney damage: UTIs can lead to kidney damage or failure

 Infertility: PID can cause infertility or ectopic pregnancy
 Pelvic abscesses: PID can lead to pelvic abscesses or fistulas
 Reactive arthritis: STIs can cause reactive arthritis

1. Cystitis: medical term for inflammation or irritation of the bladder. Can be caused by:
Bacterial infection: The most common cause of cystitis is a bacterial infection, typically
caused by Escherichia coli (E. coli), which is a type of bacteria that is commonly found in
the intestines.

Cardinal signs/symptoms:

- Dysuria (painful urination)

- Frequency (frequent urination)

- Urgency (urgent need to urinate)

- Hematuria (blood in the urine)

- Suprapubic pain (pain in the lower abdomen)

Treatment: Treatment of cystitis depends on the underlying cause and the goal of treatment is
to eradicate the infection, prevent complications and provide symptomatic relief to patients.
Early treatment is recommended to reduce the risk for progression to pyelonephritis. Appropriate
antimicrobials for cystitis include: trimethoprim-sulfamethoxazole (Bactrim), fluoroquinolones
or cephalosporins. Drinking plenty fluids can help in the treatment of cystitis

2.Urethritis: inflammation of the urethra, the tube that carries urine from the bladder to the
outside of the body. Typically caused by bacteria or viral infection, trauma: Injury to the urethra
during catheterization, surgery, or sexual activity or irritation: Exposure to chemicals, soaps, or
lotions can irritate the urethra

Symptoms of Urethritis:
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 Cardinal symptoms:

- Dysuria (painful urination)

- Frequency (frequent urination)

- Urgency (urgent need to urinate)

- Discharge (pus or blood in the urine)

- Swelling (swelling of the urethral opening)

Treatment of urethritis depends on the cause, antibiotics for bacteria, antiviral drugs for viral
cause and avoidance of irritants for irritation.

3) Ureteritis: Infection or inflammation of ureters, the tubes that connects the kidney to the
bladder and allows urine to flow from the kidney to the bladder.

Causes of Ureteritis:

1. Bacterial infections: Escherichia coli (E. coli), Klebsiella, Pseudomonas, and Enterococcus are
common causes.

2. Urinary tract abnormalities: Obstructions, narrowing, or abnormalities in the urinary tract can
increase the risk.

3. Kidney stones: Obstructions caused by kidney stones can increase the risk.

4. Trauma: Injury to the ureter during surgery or other medical procedures.

5. Cancer: Tumors in the ureter or surrounding tissues.

Symptoms of Ureteritis:

Severe flank pain (pain in the side or back)

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Treatment of Ureteritis: Antibiotics (oral or intravenous), fluid replacement, pain management
(e.g., analgesics), Surgery (to remove blockages or repair damage)

4. Pyelonephritis:

This is a type of kidney infection that occurs when bacteria or other pathogens infect the kidneys
and the renal pelvis, which is the area that collects urine and passes it to the bladder. There are 2
types acute Pyelonephritis which has sudden onset, usually caused by a bacterial infection and
chronic Pyelonephritis: Long-term or recurring infection, often due to underlying kidney
problems or structural abnormalities.

Cardinal symptoms:

- Severe flank pain (pain in the side or back)

- Fever

- Chills

- Nausea and vomiting

- Abdominal pain (pain in the lower abdomen)

Causes and Risk Factors: Bacterial infection (most common cause), Other UTIs, Kidney stones
or blockages, weakened immune system, Family history.

Complications: Kidney damage or scarring, sepsis (life-threatening infection), Kidney failure,

recurring infections

Prevention include: Practicing good hygiene, staying hydrated, urinate regularly, avoid holding
urine for long periods and manage underlying medical conditions

Reproductive System Infections

1. Vaginal Infections:
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 - Bacterial Vaginosis (BV): imbalance of vaginal flora

- Vaginal Yeast Infections (VYI): overgrowth of candida

- Trichomoniasis: infection with Trichomonas vaginalis

2. Pelvic Inflammatory Disease (PID): infection of the female reproductive organs (fallopian
tubes, ovaries, uterus)

Causes: bacteria (e.g. Neisseria gonorrhoeae, Chlamydia trachomatis), viruses (e.g. herpes
simplex), fungi (e.g. candida)

Symptoms: pelvic pain, abnormal vaginal discharge, fever, abdominal pain

Risk factors: unprotected sex, multiple sex partners, STI history, IUD use

Treatment: antibiotics (e.g. doxycycline, metronidazole), pain relief, rest

Male Reproductive System Infections

Epididymitis: inflammation of the epididymis (a tube behind the testicle)

Prostatitis: inflammation of the prostate glands

Orchitis: inflammation of the testicles

Causes: bacteria (e.g. E. coli), viruses (e.g. mumps), fungi (e.g. candida)

Symptoms: testicular pain, swelling, fever, urinary symptoms

BACILLARY DYSENTERY

Definition Bacillary dysentery is a type of dysentery, and is a severe form of shigellosis.

Shigellosis is caused by one of several types of Shigella bacteria. Three species are associated
with bacillary dysentery: Shigella sonnei, Shigella flexneri and Shigella dysenteriae
Salmonellosis caused by Salmonella enterica has also been described as a cause of bacillary

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dysentery. Bacillary dysentery should not be confused with diarrhea caused by other bacterial
infections. One characteristic of bacillary dysentery is blood in stool, which is the result of
invasion of the mucosa by the pathogen.

Causes of Bacillary Dysentery (Shigellosis)

 The shigella bacillus, a bacterium that invades the lining of the colon, is one of several
infections that can cause dysentery.
 Other causes of dysentery include the parasite amoeba and the bacteria E. coli, Yersinia,
and others.
 The shigella bacillus is typically spread via contact with the fecal matter of an infected
person.
 Failure to wash the hands thoroughly after a bowel movement may help to transmit
shigellosis.
 Flies may spread the bacteria from feces (more common in areas with poor sanitation.)
 Contaminated food or water may spread infection.

Symptoms of Bacillary Dysentery (Shigellosis)

 Watery diarrhea initially that may evolve to contain mucus and blood
 Loss of appetite
 Straining during bowel movements, with accompanying rectal pain
 Abdominal pain; body aches
 Nausea and vomiting
 Fever and chills
 Rapid dehydration and weight loss. (The very young and the elderly are especially
susceptible to dehydration.)

Prevention of Bacillary Dysentery (Shigellosis)

 To prevent the spread of infection, keep the toilet clean and wash your hands frequently
with warm water and soap, especially after a bowel movement or before handling food.
(Because dysentery has an incubation period of up to four days, you may be carrying the
disease without realizing it.)
22
  When traveling abroad or in areas with poor sanitation, drink only bottled or boiled water
or other bottled beverages, and eat only cooked foods and fruit you can peel yourself.
 Avoid contact with infected persons if possible.

Diagnosis of Bacillary Dysentery (Shigellosis)

 Dysentery is distinguished from more routine causes of infectious diarrhea by the

presence of blood.
 Physical examination and patient history are needed.
 Stool samples are taken for examination under a microscope and for a laboratory culture
to confirm the presence of the shigella bacillus.
 Colonoscopy to examine the bowels may be performed.
 Blood tests may be taken to look for electrolyte (essential mineral salt) abnormalities or
anemia.

Treat Bacillary Dysentery (Shigellosis)

 A solution of electrolytes (such as sodium and potassium) and fluids may be administered
to treat dehydration, although water or other beverages are usually sufficient. In severe
cases, fluids must be replaced intravenously.
 While waiting to see a doctor, prevent dehydration by drinking a solution of one teaspoon
salt and four teaspoons sugar in one Littre of water. It is important to measure accurately:
Too much salt may worsen dehydration. Drink one pint each hour while diarrhea persists.
 Do not take over-the-counter ant diarrheal medications unless otherwise instructed by
your doctor. Diarrhea helps rid the body of infectious organisms.
 Although the infection often clears on its own, antibiotics are often given to limit its
transmission. These must be taken for the full term prescribed.
 Isolation from others is required to prevent spread of the disease.

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CHOLERA

Cholera is an infectious disease that causes severe watery diarrhea, which can lead to
dehydration and even death if untreated. It is caused by eating food or drinking water
contaminated with a bacterium called Vibrio cholerae.

The disease is most common in places with poor sanitation, crowding, war, and famine.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water
contaminated by feces from a person with the infection. Common sources include:

 Municipal water supplies

 Ice made from municipal water
 Foods and drinks sold by street vendors
 Vegetables grown with water containing human wastes
 Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the
intestines that produces severe diarrhea.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection.
Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected
have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration.
Although many infected people may have minimal or no symptoms, they can still contribute to
spread of the infection.

Signs and symptoms of dehydration include:

 Rapid heart rate

 Loss of skin elasticity (the ability to return to original position quickly if pinched)
 Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids

24
  Low blood pressure
 Thirst
 Muscle cramps

If not treated, dehydration can lead to shock and death in a matter of hours.

Cholera Treatment and Prevention

Although there is a vaccine against cholera, the CDC and World Health Organization don't
normally recommend it, because it may not protect up to half of the people who receive it and it
lasts only a few months. However, you can protect yourself and your family by using only water
that has been boiled, water that has been chemically disinfected or bottled water. Be sure to use
the bottled, boiled, or chemically disinfected water for the following purposes:

 Drinking
 Preparing food or drinks
 Making ice
 Brushing your teeth
 Washing your face and hands
 Washing dishes and utensils that you use to eat or prepare food
 Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it
and use a commercial chemical disinfectant. You should also avoid raw foods, including the
following:

 Unpeeled fruits and vegetables

 Unpasteurized milk and milk products
 Raw or undercooked meat or shellfish
 Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or
traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is

25
highly treatable, but because dehydration can happen quickly, it's important to get cholera
treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is,
treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which
kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the
duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent
the spread of the disease.

Sexually Transmitted Diseases (STDs)

Sexually transmitted disease (STD) is a disease condition passed from one person to another
through sexual contact. A person can contract an STD by having unprotected vaginal, anal, or
oral sex with someone who has the STD. An STD may also be called a sexually transmitted
infection (STI) or venereal disease (VD). That doesn‘t mean sex is the only way STDs are
transmitted. Depending on the specific STD, infections may also be transmitted through sharing
needles and breastfeeding.

Symptoms of STDs in men

It‘s possible to contract an STD without developing symptoms. But some STDs cause obvious
symptoms. In men, common symptoms include:

 pain or discomfort during sex or urination

 sores, bumps, or rashes on or around the penis, testicles, anus, buttocks, thighs, or mouth
 unusual discharge or bleeding from the penis
 painful or swollen testiclesg

Specific symptoms can vary, depending on the STD.

Symptoms of STDs in women

In many cases, STDs don‘t cause noticeable symptoms. When they do, common STD symptoms
in women include:

26
  pain or discomfort during sex or urination
 sores, bumps, or rashes on or around the vagina, anus, buttocks, thighs, or mouth
 unusual discharge or bleeding from the vagina
 itchiness in or around the vagina

The specific symptoms can vary from one STD to another.

Types of STDs

Many different types of infections can be transmitted sexually. The most common STDs are

Chlamydia

Chlamydia is the most common STI caused by a bacteria called chlamydia Trachomatis.

Many people with chlamydia have no noticeable symptoms. When symptoms do develop, they
often include:

 pain or discomfort during sex or urination

 green or yellow discharge from the penis or vagina
 pain in the lower abdomen

If left untreated, chlamydia can lead to:

 infections of the urethra, prostate gland, or testicles

 pelvic inflammatory disease
 infertility

If a pregnant woman has untreated chlamydia, she can pass it to her baby during birth. The baby
may develop:

 pneumonia
 eye infections
 blindness

Antibiotics can easily treat chlamydia

27
Syphilis

Syphilis is another bacterial infection caused by a bacterial known as Treponema Palladium.

There are four stages of syphilis infection namely: primary stage, secondary, latent and tertiary
stage .The first symptom to appear is a small round sore, known as a chancre (primary syphilis).
It can develop on the genitals, anus, or mouth. It‘s painless but very infectious. . It often goes
unnoticed in its early stages if not treated (secondary stage).

Later symptoms of syphilis (latent syphilis) can include:

 rash
 fatigue
 fever
 headaches
 joint pain
 weight loss
 hair loss

If left untreated, late-stage (tertiary syphilis) can lead to:

 loss of vision
 loss of hearing
 loss of memory
 mental illness
 infections of the brain or spinal cord
 heart disease
 death

Fortunately, if caught early enough, syphilis is easily treated with antibiotics. However, syphilis
infection in a newborn can be fatal. That‘s why it‘s important for all pregnant women to be
screened for syphilis.

The earlier syphilis is diagnosed and treated, the less damage it does.

HIV
28
HIV is a virus that can damage the immune system and raise the risk of contracting other viruses
or bacteria and developing certain cancers. If left untreated, it can lead to stage 3 HIV, known as
AIDS. But with today‘s treatment, many people living with HIV do not develop AIDS.

In the early or acute stages, it‘s easy to mistake the symptoms of HIV with those of the flu. For
example, the early symptoms can include:

 fever
 chills
 aches and pains
 swollen lymph nodes
 sore throat
 headache
 nausea
 rashes

These initial symptoms typically clear within a month or so. From that point onward, a person
can carry HIV without developing serious or persistent symptoms for many years. Other people
may develop nonspecific symptoms, such as:

 recurrent fatigue
 fevers
 headaches
 stomach issues

There‘s no cure for HIV yet, but treatment options are available to manage it. Early and effective
treatment can help people with HIV live as long as those without HIV.

Proper treatment can also lower a person‘s chances of transmitting HIV to a sexual partner. In
fact, treatment can potentially lower the amount of HIV in a person‘s body to undetectable
levels. At undetectable levels, HIV cannot be transmitted to other people according to CDC.

Without routine testing, many people with HIV don‘t realize they have it. To promote early
diagnosis and treatment, the CDC recommends that everyone between the ages of 13 and 64 be

29
tested at least once. People at high risk of HIV should be tested at least once a year, even if they
don‘t have symptoms.

Free and confidential testing can be found in all major cities and many public health clinics. A
government tool for finding local testing services is available.

With recent advancements in testing and treatment, it‘s possible to live a long and healthy life
with HIV.

Gonorrhea

Gonorrhea is another common bacterial STD caused by Neisseria gonorrhea. It‘s also known as
―the clap. ―Many people with gonorrhea develop no symptoms. But when present, symptoms
may include:

 a white, yellow, beige, or green-colored discharge from the penis or vagina

 pain or discomfort during sex or urination
 more frequent urination than usual
 itching around the genitals
 sore throat

If left untreated, gonorrhea can lead to:

 infections of the urethra, prostate gland, or testicles

 pelvic inflammatory disease
 infertility

It‘s possible for a mother to pass gonorrhea to a newborn during childbirth. When that happens,
gonorrhea can cause serious health problems in the baby. That‘s why many doctors encourage
pregnant women to get tested and treated for potential STDs. Gonorrhea can usually be treated
with antibiotics.

Trichomoniasis

30
Trichomoniasis is also known as ―trich.‖ It‘s caused by a tiny protozoan organism known as
Trichomonas that can be passed from one person to another through genital contact.

Symptoms may include:

 discharge from the vagina or penis

 burning or itching around the vagina or penis
 pain or discomfort during urination or sex
 frequent urination

In women, trich-related discharge often has an unpleasant or ―fishy‖ smell. If left untreated, trich
can lead to:

 infections of the urethra

 pelvic inflammatory disease
 infertility

Trich can be treated with antibiotics and antiprotozoans eg metronidazole

GENITAL HERPES

It is a common sexually transmitted infection (STI). The herpes simplex virus (HSV) causes
genital herpes. It can often be spread by skin-to-skin contact during sexual activity. Some people
infected with the virus may have very mild symptoms or no symptoms. They can still able to
spread the virus. Other people have pain, itching and sores around the genitals, anus or mouth.

There is no cure for genital herpes. Medicine can ease symptoms. It also lowers the risk of
infecting others. Condoms can help prevent the spread of a genital herpes infection.

HEPATITIS (viral hepatitis)

31
Viral hepatitis is an inflammation of the liver that is caused by a virus. There are five types, but
the most common ones are hepatitis A, B, and C. All of them affect the liver. Some of the
symptoms are similar, but they have different treatments.

Hepatitis A. Caused by the hepatitis A virus (HAV), contagious and spreads through close
person-to-person contact or by eating or drinking contaminated food or drink. This type won't
lead to long-term infection and usually doesn't cause any complications. The liver heals in about
2 months. It can be prevented with a vaccine.

Hepatitis B. Caused by the hepatitis B virus (HBV), contagious and spreads through bodily
fluids like blood and semen. Most people recover from this type in 6 months. Sometimes,
though, it causes a long-term infection that could lead to liver damage. Once an individual gets
the disease, he/she can spread the virus even if they don't feel sick. Persons who are vaccinated
won't catch it.

Hepatitis C. Caused by the hepatitis C virus (HCV). Many people with hepatitis C don't look or
feel sick, so they might not know they have the virus. Many people with this type don't have
symptoms. About 80% of those with the disease get a long-term infection. It can sometimes lead
to cirrhosis, a scarring of the liver. There's no vaccine to prevent it.

The symptoms of hepatitis can be confounding, ranging from mild, short-lived flu-like symptoms
(e.g., fever and fatigue) to more classic ones, such as jaundice—or even no symptoms at all.
Typically, once the symptoms of hepatitis become obvious, chronic liver disease and liver
damage are well underway. Serious liver damage can have dire and even life-threatening
complications such as cirrhosis and liver cancer.

To treat symptoms of hepatitis, health care providers usually recommend rest, eating a well-
balanced diet and getting plenty of fluids. There are no medications for acute hepatitis B. There
are some medications for chronic hepatitis B; they aren't a cure.

TETANUS (LOCKJAW)

Definition Tetanus is a serious bacterial infection that affects the nervous system and causes
muscles throughout the body to tighten. It‘s also called lockjaw because the infection often
32
causes muscle contractions in the jaw and neck. However, it can eventually spread to other parts
of the body.

Tetanus infection can be life-threatening without treatment. Tetanus is a medical emergency that
requires immediate treatment in a hospital. Fortunately, tetanus is preventable through the use of
a vaccine. However, this vaccine does not last forever. Tetanus booster shots are needed every 10
years to ensure immunity.

Causes

Bacteria called Clostridium tetani cause tetanus. Spores of the bacteria can be found in dust, dirt,
and animal droppings. Spores are small reproductive bodies produced by certain organisms.
They‘re often resistant to harsh environmental conditions, such as high heat.

A person can become infected when these spores enter the bloodstream through a cut or deep
wound. The bacteria spores then spread to the central nervous system and produce a toxin called
tetanospasmin. This toxin is a poison that blocks the nerve signals the spinal cord to muscles.
This can lead to severe muscle spasms.

Tetanus infection has been associated with:

 Crush injuries
 Injuries with dead tissue
 Burns
 Puncture wounds from piercings, tattoos, injection drug use, or injury (such as stepping
on a nail)
 Wounds contaminated with dirt, feces, or saliva

Less commonly, it’s been associated with:

 animal bites
 dental infections
 insect bites
 chronic sores and infections

33
Tetanus is not contagious from person to person. The infection occurs worldwide, but is more
common in hot, damp climates with rich soil. It‘s also more common in densely populated areas.

Symptoms

Tetanus affects the nerves that control the muscles, which can lead to difficulty swallowing. One
may also experience spasms and stiffness in various muscles, especially those in the jaw,
abdomen, chest, back, and neck.

Other common tetanus symptoms are:

 Fast heart rate

 Fever
 Sweating
 High blood pressure

The incubation period, the time between exposure to the bacteria and the onset of illness is
between 3 and 21 days. Symptoms typically appear within 14 days of initial infection. Infections
that occur faster after exposure are typically more severe and have a worse prognosis.

Diagnosis

The doctor will perform a physical exam to check for symptoms of tetanus, such as muscle
stiffness and painful spasms.

Unlike many other diseases, tetanus is not generally diagnosed through laboratory tests.
However, the doctor may still perform lab tests to help rule out diseases with similar symptoms.
These include meningitis, a bacterial infection that affects the brain and spinal cord, or rabies, a
viral infection that causes brain swelling.

The doctor will also base a tetanus diagnosis on the immunization history of the patient. You‘re
at a higher risk of tetanus if you haven‘t been immunized or if you‘re overdue for a booster shot.

Treatment

34
Treatment depends on the severity of the symptoms. Tetanus is typically treated with a variety of
therapies and medications, such as:

 antibiotics such as penicillin to kill the bacteria in the system

 tetanus immune globulin (TIG) to neutralize the toxins that the bacteria have created in
the body
 muscle relaxers to control muscle spasms
 a tetanus vaccine given along with the treatment
 cleaning the wound to get rid of the source of the bacteria

In some cases, a surgical procedure called debridement is used to remove dead or infected tissue.
If you have difficulty swallowing and breathing, you may need a breathing tube or ventilator (a
machine that moves air in and out of the lungs).

Complications

Severe muscle spasms as a result of tetanus can also cause serious health complications, such as:

 breathing problems due to spasms of the vocal cords (laryngospasm) and spasms of the
muscles that control breathing
 pneumonia (an infection of the lungs)
 brain damage due to lack of oxygen
 abnormal heart rhythm
 bone fractures and fractures of the spine due to muscle spasms and convulsions
 secondary infections due to prolonged hospital stays

Prevention

Vaccination can prevent tetanus infections, but only if you receive your booster shots on
schedule. In the United States, the tetanus vaccine is given to children as part of the diphtheria-
tetanus-pertussis shot, also called the DTap shot. This is a three-in-one vaccine that protects
against diphtheria, pertussis, and tetanus. However, it doesn‘t provide lifelong protection.
Children need to get a booster shot at 11 or 12 years of age. Adults then need a booster vaccine

35
called the Td vaccine (for tetanus and diphtheria) every 10 years after that. Proper treatment and
cleaning of wounds can also help prevent the infection.

Prognosis

Without treatment, tetanus can be fatal. Death is more common in young children and older
adults. Prompt and proper treatment will improve the prognosis even if you get tetanus once; you
can still get it again someday if you‘re not protected by the vaccine. The vaccine is extremely
effective, according to the CDC. Reports of tetanus occurring in fully immunized people who
have received a vaccine or booster within the last 10 years are very rare.

TUBERCULOSIS

Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis

(MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the
body. Most infections do not have symptoms, in which case it is known as latent tuberculosis.
About 10% of latent infections progress to active disease which, if left untreated, kills about half
of those affected. The classic symptoms of active TB are a chronic cough with blood-containing
sputum, fever, night sweats, and weight loss.

Mode of Transmission

Tuberculosis is spread through the air when people who have active TB in their lungs cough,
spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs
more often in people with HIV/AIDS and in those who smoke
Signs and Symptoms

Tuberculosis may infect any part of the body, but most commonly occurs in the lungs (known as
pulmonary tuberculosis). Extra pulmonary TB occurs when tuberculosis develops outside of the
lungs, although extra pulmonary TB may coexist with pulmonary TB.

General signs and symptoms include fever, chills, night sweats, coughing out blood (
hemoptysis),loss of appetite, weight loss, and fatigue. Significant nail clubbing may also occur.

36
Pulmonary

If a tuberculosis infection does become active, it most commonly involves the lungs. Symptoms
may include chest pain and a prolonged cough producing sputum. About 25% of people may not
have any symptoms (i.e. they remain "asymptomatic"). Occasionally, people may cough up
blood in small amounts, and in very rare cases, the infection may erode into the pulmonary artery
resulting in massive bleeding. Tuberculosis may become a chronic illness and cause extensive
scarring in the upper lobes of the lungs. The upper lung lobes are more frequently affected by
tuberculosis than the lower ones. The reason for this difference is not clear. It may be due to
either better air flow, or poor lymph drainage within the upper lungs.

Extra Pulmonary

The infection spreads outside the lungs, causing other kinds of TB. These are collectively
known as "extra pulmonary tuberculosis". Extra pulmonary TB occurs more commonly in people
with a weakened immune system like those with HIV and young children. Extra pulmonary
infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in
tuberculosis meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system
(in urogenital tuberculosis), and the bones and joints (in Pott disease of the spine), among others.

Causes

The main cause of TB is Mycobacterium tuberculosis (MTB)

Risk Factors

The most important risk factor globally is HIV

Tuberculosis is closely linked to both overcrowding and malnutrition

Those at high risk thus include:

People who inject illicit drugs, inhabitants and employees of locales where vulnerable people
gather (e.g. prisons and homeless shelters), medically underprivileged, high-risk ethnic

37
minorities, children in close contact with high-risk category patients, and health-care providers
serving these patients.

Chronic lung disease is another significant risk factor. Those who smoke cigarettes have nearly
twice the risk of TB compared to nonsmokers.

Other disease states can also increase the risk of developing tuberculosis. These include
alcoholism and diabetes mellitus .

Certain medications, such as corticosteroids are important risk factors, especially in the
developed world.

Transmission

When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious
aerosol droplets. Each one of these droplets may transmit the disease, since the infectious dose of
tuberculosis is very small (the inhalation of fewer than 10 bacteria may cause an infection).

People with prolonged, frequent, or close contact with people with TB are at particularly high
risk of becoming infected, a person with active but untreated tuberculosis may infect 10–15 (or
more) other people. Transmission should occur from only people with active TB – those with
latent infection are not thought to be contagious. The probability of transmission from one person
to another depends upon several factors, including the number of infectious droplets expelled by
the carrier, the effectiveness of ventilation, the duration of exposure, the virulence of the M.
tuberculosis strain, the level of immunity in the uninfected person, and others.

Diagnosis

Active Tuberculosis

A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial
evaluation.

A definitive diagnosis of TB is made by identifying M. tuberculosis in a clinical sample (e.g.,

sputum, pus, or a tissue biopsy). However, the difficult culture process for this slow-growing

38
organism can take two to six weeks for blood or sputum culture. Thus, treatment is often begun
before cultures are confirmed.

Latent Tuberculosis

The Mantoux tuberculin skin test is often used to screen people at high risk for TB. Those who
have been previously immunized with the Bacille Calmette-Guerin (BCG) vaccine may have a
false-positive test result. The test may be falsely negative in those with sarcoidosis, Hodgkin's
lymphoma, malnutrition, and most notably, active tuberculosis

Prevention

Tuberculosis prevention and control efforts rely primarily on the vaccination of infants and the
detection and appropriate treatment of active cases (USPSTF) recommends screening people
who are at high risk for latent tuberculosis with either tuberculin skin tests or interferon-gamma
release assays.

Vaccines

The only available vaccine as of 2011 is Bacillus Calmette-Guérin (BCG). In children it

decreases the risk of getting the infection .The immunity it induces decreases after about ten
years. BCG is administered only to those people at high risk. Part of the reasoning against the
use of the vaccine is that it makes the tuberculin skin test falsely positive, reducing the test's
usefulness as a screening tool. A number of new vaccines are currently in development.

Management

Treatment of TB uses antibiotics to kill the bacteria. Latent TB is treated with either isoniazid
alone, or a combination of isoniazid with either rifampicin or rifapentine. The treatment takes at
least three months. People with latent infections are treated to prevent them from progressing to
active TB disease later in life.

Active TB disease is best treated with combinations of several antibiotics to reduce the risk of
the bacteria developing antibiotic resistance.

39
New onset

The recommended treatment of new-onset pulmonary tuberculosis, as of 2010, is six months of a

combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and ethambutol for
the first two months, and only rifampicin and isoniazid for the last four months. Where resistance
to isoniazid is high, ethambutol may be added for the last four months as an alternative.

Recurrent disease

If tuberculosis recurs, testing to determine which antibiotics it is sensitive to is important before

determining treatment. If multiple drug-resistant TB (MDR-TB) is detected, treatment with at
least four effective antibiotics for 18 to 24 months is recommended.

Medication Administration

Directly observed therapy, i.e., having a health care provider watch the person take their
medications, is recommended by the WHO in an effort to reduce the number of people not
appropriately taking antibiotics. The evidence to support this practice over people simply taking
their medications independently is of poor quality. Methods to remind people of the importance
of treatment and appointments may result in a small but important improvement.

Medication Resistance

Primary resistance occurs when a person becomes infected with a resistant strain of TB. A
person with fully susceptible MTB may develop secondary (acquired) resistance during therapy
because of inadequate treatment, not taking the prescribed regimen appropriately (lack of
compliance), or using low-quality medication. Drug-resistant TB is a serious public health issue
in many developing countries, as its treatment is longer and requires more expensive drugs.
MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and
isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of
second-line drugs. Totally drug-resistant TB is resistant to all currently used drugs. It was first
observed in 2003 in Italy.

Prognosis

40
Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune
system defenses and begin to multiply .The risk of reactivation increases with
immunosuppression, such as those caused by

Infection with HIV. In people coinfected with M. tuberculosis and HIV, the risk of reactivation
increases to 10% per year.

Stigma

TB. Stigma may be due to the fear of transmission from affected individuals. This stigma may
additionally arise due to links between TB and poverty, and in Africa, AIDS. Such stigmatization
may be both real and perceived; for example, in Ghana individuals with TB are banned from
attending public gatherings.

Stigma towards TB may result in delays in seeking treatment, lower treatment compliance, and
family members keeping cause of death secret allowing the disease to spread further.

One way to decrease stigma may be through the promotion of "TB clubs", where those infected
may share experiences and offer support, or through counseling. Some studies have shown TB
education programs to be effective in decreasing stigma, and may thus be effective in increasing
treatment adherence.

NURSING IN AN INFECTION UNIT (BARRIER NURSING)

Also known as source isolation, barrier nursing is a form of medical treatment where the patient
receives care while taking every precaution to protect medical staff from contracting the disease
whilst also protecting the patient from further illness.

Barrier nursing is required in hospital wards or care facilities where diseases are easily spread. In
these settings, patients with certain symptoms must be isolated immediately before a diagnosis
can be made. Symptoms that lead to barrier nursing can include diarrhea, vomiting, undiagnosed
rashes, suspected streptococcal infection, and bacterial meningitis. In these cases, barrier nursing
(or source isolation) is implemented to protect medical workers and to ensure that any harmful
bacteria is contained.

41
It is also important to understand that the infected patient may have a weakened immune system.
Not only does barrier nursing protect others within the vicinity but the process also limits any
other bacteria coming into contact with the patient in the interest of their safety.

Key Practices in Barrier Nursing:

Hand Hygiene in nursing: Proper hand washing or the use of hand sanitizers is the fundamental
practice in infection control nursing. Clean hands significantly reduce the risk of spreading
infections.

Personal Protective Equipment (PPE): Healthcare providers should utilize appropriate PPE,
including gloves, gowns, overalls, footwear, facial coverings, masks, and eye protection, when
caring for patients in isolation. PPE acts as a physical barrier, preventing direct contact and the
transmission of infectious agents.

Environmental Control in isolation nursing: Maintaining a clean and hygienic environment is

essential in isolation nursing. Regular cleaning and disinfection of surfaces, equipment, and
patient care areas minimize the survival and spread of pathogens.

Safe Handling of Contaminated Materials: Proper disposal of contaminated materials, such as

used gloves, masks, and dressings, is crucial to prevent cross-contamination and ensure the
safety of both patients and healthcare providers.

42