Chapter 13: Infectious Diseases

(Week 26, 27 & 28)

PowerPoint® Slides
by Ms Lina Tang

1
Learning Objective (s)
• Understanding infectious diseases – cholera, malaria,
AIDS and TB

• Understanding the prevention and control of these

diseases

• Understanding the role of antibiotics in the treatment of

infectious disease

2
Learning Outcome (s)
• Explain the term infectious disease

• Describe the causes of cholera, malaria, AIDS and TB

• Explain how these diseases are transmitted

• Discuss the roles of social, economic and biological

factors in the prevention and control of these diseases

• Outline the role of antibiotics in the treatment of

infectious disease

3
Introduction
• Infectious disease:
▫ Transmissible, or communicable diseases
▫ Direct contact – infected person to indirect person
▫ Indirect contact – pathogens that can survive outside human body
– from environment to human – some might not have it but carry
and spread it (carriers)
▫ International travel
• The way pathogen passes from one host to another 
transmission cycle

• Control methods  break the transmission cycle by

removing the conditions that favour the spread of the
pathogen

• Only possible when cause and method of transmission

known
Four infectious diseases in this chapter:

1. Cholera
2. Malaria
3. Tuberculosis (TB)
4. AIDS
1940s – with antibiotics, success in treatment is high

• The threat now:

Antibiotics overuse  resistance in bacteria

Cholera
• New strain appeared in 1992 – eighth pandemic of the
disease

Pathogen Vibrio cholerae

Methods of transmission food-borne, water-borne
Global distribution Asia, Africa, Latin America
Incubation period 1-5 days
Site of action of pathogen wall of small intestine
severe diarrhoea ('rice water'), loss of water
Clinical featres
and salts, dehydration, weakness
Method of diagnosis microscopical analysis of faeces
Annual incidence
5.5 million
worldwide
Annual mortality
120,000
worldwide
• Water-borne caused by improper sanitation,
contaminated food and water supply

• In infected persons, ¾ are symptomless carrier, pass out

large number of bacteria in their faeces

• To reach small intestine (site of action), bacteria have to

pass through the stomach (<pH 4.5) where they are
unlikely to survive
• Those that pass through:
▫ Multiply and secrete toxin, choleragen
▫ Disrupt function of epithelium
▫ Salts and water leave the blood – severe diarrhoea
▫ Causing loss of water
▫ Fatal if not treated within 24 hours
• All ppl with cholera who are treated – quick recovery

• Death from cholera = avoidable death

▫ Controlled by giving a sltn of salts and glucose to rehydrate the
body
▫ Either intravenously or by oral
• 60 different strains of V. cholerae
▫ Until 1990s – only strain ‘01’ known

• Between 1817 and 1923  six pandemics of

cholera
▫ All originated in Bangladesh – caused by ‘classical’
strain of cholera 01

• 7th pandemic – 1961

▫ Originated from Indonesia  India  Italy (1973) 
South America (1991)  epidemic in Peru
What do you think are the possible factors that favour the
spread of cholera?
Malaria
• Increase since 1970s – esp. in tropical countries
Plasmodium falciparum
Pathogen
P. vivax, P. ovale, P. malariae
Methods of transmission Insect vector: female Anopheles mosquito
Throughout the tropics and sub-tropics
Global distribution
(endemic in 91 countries)
Incubation period From a week to a year
Site of action of pathogen Liver, red blood cells, brain
Fever, anaemia, nausea, headaches, muscle
Clinical featres
pain, shivering, sweating, enlarged spleen
Method of diagnosis Microscopical examination of blood
Annual incidence
300 million (90& of cases are in Africa)
worldwide
Annual mortality 1.5-2.7 million; in tropical Africa, malaria kills 1
worldwide million children under the age of 5
• Mosquitoes feed on infected human and some of
the pathogen’s gametes present in the blood was
ingested as well

• Gametes then fuse and develop in mosquito’s gut to

form infective stages, which move to the salivary
glands

• Pathogen is passed to human through anticoagulant

in saliva that is injected when the mosquito feed
again
• The parasites then enter the red blood cells and multiply
in it

• The transmission cycle repeats again

• Female mosquito  vector for the disease

• Other alternatives include:

▫ Blood transfussion
▫ Unsterile needles reused
▫ Pass across placenta from mother to fetus
• Plasmodium multiplies in both hosts –
▫ human and mosquito

• At each stage, there is a huge increase in the number of

parasites
▫ Improves the chances of infecting another mosquito or human
host
• If continually reinfected  immune to malaria
▫ However, only happens if they survive the 1st 5 yrs of life when
mortality from malaria is very high

• The immunity only lasts as long as they are in contact

with the disease
• Epidemics in places that malaria is not endemic can be
serious

• Might be misdiagnosed with influenza

• Means of control:

▫ Kill the mosquitoes

 Oil spread over surface of water
 Marshes drained, vegetation cleared
 Biological control:
 Fish in ponds to feed on mosquito larvae
 Spray that contain bacterium Bacillus thuringiensis which kills
mosquito larvae but not other forms of life
▫ Avoid being beaten by the mosquitoes
 Mosquito net
 Soaking net in insecticide

▫ Drugs preventing parasite infecting people

 Quinine and chloroquine (inhibit protein synthesis)
 Taken before, during and after visiting an area where malaria is
endemic
• 1950s, WHO  eradication prog for malaria
▫ Not generally successful

• Reasons:
▫ Plasmodium became resistant
▫ Mosquitoes became resistant to DDT and other insecticides used
that time

• Expensive, unpopular
 Reasons for worldwide concern:
1. Increase in drug-resistance forms of Plasmodium
2. An increase in the proportion of cases caused by P.
falciparum, the form that causes severe, often fatal malaria
3. Difficulties in developing a vaccine
4. An increase in the number of epidermics because of climatic
and environmental changes that favour the spread of
mosquitoes
5. The migration of people as a result of civil unrest and war
6. 40% of the world’s population live in areas of risk in malaria
• Control:
▫ Improve diagnosis
▫ Improve supply of effective drugs
▫ Promote appropriate methods to prevent transmission
▫ Genome of Plasmodium sequenced – development of effective
vaccine
AIDS
• Officially recognised in 1981

• But the infective agent (HIV) was in human populations

for many years before it was identified

• But early 1980s, the spread has been exponential

Pathogen Human Immunodeficiency Virus
Methods of transmission In semen and vaginal fluids during sexual
intercourse,
Infected blood or blood products,
Contaminated hypodermic syringes,
Mother to fetus across placenta,
Mother to infant in breast milk
Global distribution Worldwide, especially in sub-Saharan Africa and
South-East Asia
Incubation period Initial incubation a few weeks, but up to ten years or
more before symptoms of AIDS may develop
Site of action of T helper lymphocytes, macrophages, brain cells
pathogen
Clinical features
Method of diagnosis
Estimated total number of people
infected with HIV worldwide in 2002
Estimated number of new cases of
HIV infection worldwide in 2002
Estimated number of deaths from
AIDS-related diseases worldwide in
2002
HIV infection – flu-like symptoms and
then symptomless;
AIDS – opportunistic infections
including pneumonia, TB, cancers;
Weight loss, diarrhoea, fever,
sweating, dementia
Blood test for antibodies to HIV
42 million (2007 – 33 million)
5 million
(2007 – 2.7 million)
3.1 million (one third due to TB)
(2007 – 2 million)
• Caused by HIV (Human Immunodeficiency virus)
• HIV infects and destroys cells of the body’s immune
system
▫ T helper lymphocytes  important in immune system’s response
to infection
▫ Lymphocytes destroyed  defence mechanism of the body is
affected
▫ Allowing other pathogens to cause opportunistic infections
• AIDS itself is not a disease

• But is a collection of rare opportunistic diseases

associated with immunodeficiency caused by HIV

• First identified in 1980s  epidemic  pandemic

At the end of 2009, women accounted for just over half of all adults living with HIV worldwide.

Estimate Range

People living with HIV/AIDS in 2009 33.3 million 31.4-35.3 million

Adults living with HIV/AIDS in 2009 30.8 million 29.2-32.6 million
Women living with HIV/AIDS in 2009 15.9 million 14.8-17.2 million

Children living with HIV/AIDS in 2009 2.5 million 1.6-3.4 million

People newly infected with HIV in 2009 2.6 million 2.3-2.8 million

Adults newly infected with HIV in 2009 2.2 million 2.0-2.4 million

AIDS deaths in 2009 1.8 million 1.6-2.1 million

Orphans (0-17) due to AIDS in 2009 16.6 million 14.4-18.8 million

• No vector involved (unlike in malaria)
▫ Spread by intimate human contact

• Unable to survive outside human body (unlike cholera

and malaria pathogens)
• Spread through intimate human contact

• Transmission by direct exchange of body fluids

▫ Sexual intercourse
▫ Blood donation
▫ Sharing of intravenous needles
▫ Across the placenta from mother to fetus
There is higher chance of
AIDS

In homosexual??
1. Anal intercourse
- mucous lining of the rectum is not as thick as that of the
vagina
- less natural lubrication
- easily damaged during intercourse and virus can pass from
semen to blood

2. Many sex partners

In sub-Saharan Africa
• 80% of the world’s deaths from AIDS occur in Africa
• 34 million estimated to be infected and 11.4
estimated to have die
• 5.9 million children, estimated to be orphaned by
AIDS

• Average life expectancy in South Africa dropped

from 65 to 55 during 1995-1999
• World Bank estimated that AIDS had reversed 10-15
years of economic growth for some African states
• HIV – slow virus, may not be any symptoms

• Some do show early symptoms – flu-like

• At this stage, the person is HIV-positive but does not

have AIDS

• The infections can opportunistically develop to create

AIDS depending on the condition
Prevention
• No cure for AIDS
• No vaccine for HIV
• Drug therapy only slows down the onset of AIDS
• But it is expensive and have some side effects
▫ Mild and temporary (rashes, headaches, diarrhoea)
▫ Severe and permanent (nerve damage, abnormal fat distribution)
• Drug used
▫ Zidovudine (Similar to the nucleotide that contains the base
thymine)
▫ Binds to the viral enzyme reverse transcriptase and blocks its
action
▫ Stops the replication of the viral genetic material
▫ Increase in body’s lymphocytes
▫ The course of drug must be followed strictly to avoid resistance
developed in the virus
• Why the developement of vaccine against HIV is so
hard?
▫ Cause the virus changes its surface proteins, making it hard for
the body’s immune system to recognise it
Tuberculosis (TB)
• Once thought to be nearly eradicated
Pathogen Mycobacterium tuberculosis; M. bovis
Methods of transmission Airborne droplets; via unpasteurised milk
Global distribution Worldwide
Incubation period Few weeks or months
Primary infection in lungs; secondary
Site of action of pathogen
infection in lymph nodes, bones and gut
Racking cough, coughing blood, chest pain,
Clinical featres shortness of breath, fever, sweating, weight
loss
microscopical examination of sputum for
Method of diagnosis
bacteria, chest X-ray
Annual incidence
8 million
worldwide
Annual mortality
2 million
worldwide
Tuberculosis
• Pathogens live inside human cells, particularly in the
lungs, which are also the first site of infection
• But it can spread throughout the whole body and infect
bone tissue
• Some being infected quickly, while some remains
inactive in the body for many years (30% in estimate)
• Symptoms:
▫ Cough – defense mechanism of the body
▫ Cell release hormone-like compounds
▫ Causes fever
▫ Suppress the appetite
▫ Weight loss
• For inactive bacteria,
▫ Activated later in life
▫ Onset cause by the individual are weakened by other diseases
such as HIV infection or poor immune system
TB and HIV
• Tuberculosis is now the leading cause of death of HIV-
positive people

• HIV infected person, destroy o the immune system 

more susceptible to bacteria and virus infection

• HIV pandemic is closely followed by the TB pandemic

• TB spread
▫ active bacteria is coughed or sneezed
▫ Then the airborne droplet spread around in the air
▫ Once inhaled, the person is infected
▫ The spread is particularly common in overcrowded living
environment, such as the refugee camp, squatter area etc
Another Way of Spread
• Bacteria M. bovis

▫ Can also occur in cattle

▫ Spread to human in meat and milk

Treatment of TB
• Introduction of Streptomycin in 1940s
• Successful in the treatment of TB
• Treatment of TB involves using several drugs to
ensure all bacteria killed
• Treatment is a long one (nine months to a year)
▫ Cause slow growing and are not very sensitive to the
drugs
• Many do not complete their course of drugs
▫ They thought that they are cured when they feel better
▫ But some bacteria survived and multiply
Resurgence of TB
• But now, TB cases showing resurgence:
▫ Some strains of TB bacteria develop resistance to the
drug
▫ AIDS pandemic
▫ Poor housing or expensive housing in developed
countries – increase in homelessness
▫ Migration
▫ Breakdown of TB control programmes
 Partial treatment for TB increases the chance of drug
resistance
Drug resistance
• Strains of drug-resistant M. tuberculosis were identified
in 1950s in treatment with antibiotics

• Antibiotics – act as selective agents killing drug-sensitive

strains and leaving resistant one behind
• Resistance occur as a result of mutation in bacterial
DNA

• Mutation:
▫ Random
▫ 1/1000 bacteria of frequency
• 3 drugs used in combination for treatment
▫ Chance of resistance by mutation= 1/ thousand million

• 4 drugs used
▫ Resistance by mutation = 1/ a billion
• People who do not complete the treatment

• Higher risk of mutation and drug resistance developed

• Highly likely to infect others with drug-resistance forms

of TB

• Estimated one person  10-15 others

• In treatment, tracing and testing of patient is needed to
ensure the cure

• In prevention, vaccine are used, especially in children

• Prevent infection from cow to human

▫ Cattle routinely tested for TB
▫ Pasteurise the milk, killing the bacteria
Antibiotics
• Drugs used to treat or cure infections

• Effective antibiotics – shows selective toxicity  killing

or disabling the pathogen but have no effect on host
cells

• Can be natural or synthetic

• Antibiotics interfere with some aspect of growth or
metabolism of the organism:

▫ Synthesis of bacterial walls

▫ Protein synthesis (transcription & translation)
▫ Plasma mb function
▫ Enzyme function
• Penicillin
▫ Preventing the synthesis of the cross-links between
the peptidoglycan polymers in the cell walls of bacteria

• Only effective against bacteria and only while

they are growing

• Many types of bacteria have enzymes for

destroying penicillins (penicillinases)  resistant
to these antibiotics
• Screening of antibiotics ensure effective treatment

• Plate of bacteria with antibiotics  inhibition zone

produced

• Diameter measured
References:
Jones, M. 2007, AS/A Level Biology (Cambridge
International Examinations), 2nd edn, Cambridge
University Press.

Jones, M. 2010. Cambridge International A/AS-Level

Biology: Revision Guide, Trans-Atlantic Publications.

69
Key terms:

Term Definition
Antibiotics A substance produced by a living organism that is
capable of destroying or inhibiting the growth of a
microorganism

The transfer of a pathogen from one person to

Transmission another