Infectious Diseases

1. Tuberculosis
• Tuberculosis is a highly contagious bacterial infection that primarily affects the
lungs. It has the potential to spread to other parts of the body, such as the brain and spine.
• Tuberculosis is also called as Koch's disease since it was first discovered in 1882
by Robert koch.
• TB bacteria are small, aerobic and non motile bacillus. Cell wall of these bacteria
is made up of mycolic acid. They canbe identified by acid fast staining.
Etiopathogenesis
• TB is an infectious disease caused by bacteria from the Mycobacterium tuberculosis
complex, the most common and important of which is Mycobacterium tuberculosis. M.bovis,
M.africanum, and M.microti, all closely related mycobacteria, can cause similar disease.
Robert Koch proved in 1882 that the tubercle bacillus was the true cause of tuberculosis, for
which he was awarded the Nobel Prize in 1905.
• Mycobacterium tuberculosis is spread through the air in droplet nuclei, which are
formed when people with pulmonary or laryngeal tuberculosis cough, sneeze, shout, or sing.
Depending on the environment and ventilation, these particles which range in size from one
to five microns in diameter, can linger in the air for several hours.
• Risk Factors for Tuberculosis:-
• Crowded living conditions
• Under nutrition
• Homelessness
• Close contact with a patient with active TB infection
• Working in the Health care industry
• Migration from region with a high TB burden
• Clinical Manifestation
1. Coughing that lasts three weeks or longer.
2. Coughing blood.
3. Pain in the chest, or pain when breathing or coughing.
4. Weight loss that occurs unintentionally.
5. Fatigue.
6. Sweats at night.
7. Chills.
8. Appetite loss.
9. High temperature 100.4°F 38°C) and above
• Example of symptoms of extrapulmonary TB are, swelling of a lymph node in TB
lymphadenitis, pain and swelling of a joint in TB arthritis, neck stiffness and disorientation in
a case of TB meningitis.

• Non -pharmacological Management

1. Take balance and healthy diet.
2. Take maximum rest.
3. Keep balance in daily activity.
4. Increase immunity by taking nutritional food.
5. Medical personnel must wear disposable masks with a high efficiency rating.
6. Patients with a possible tuberculosis infection should be isolated in a private room.
7. Patients were encouraged to maintain good cough hygiene.
8. Supplement with Vitamins and minerals as needed.
9. For the duration of the illness , an integrated nutritional assessment, counselling, and support will
be provided.
• Pharmacological Management
1) First line drugs:- eg. Ethambutol, Pyrazinamide, Rifampicin, Streptomycin, Isoniazide.
2) Second line drugs:- eg. cycloserine, Amikacin, Ethionamide, Fluroquinolones, para-aminosalicylic
acid, Capreomycin.
3) Newer drugs:- eg. Azithromycin, linezolid, thioacetazole.

2. Pneumonia
• Pneumonia is a respiratory infection in one or both the lungs caused by bacteria,
viruses, or fungi. It is characterized by inflammation of the alveolar space and /or the
intestinal tissue of lungs. Pneumonia that is result from the aspiration of stomach contents is
known as aspiration pneumonia.
• Both viral and bacterial pneumonia are contagious. This means they spread from
person to person through inhalation of airborne droplets from a sneeze or cough. On the
other hand, the fungal pneumonia does not spread from person to person.

• Etiopathogenesis
• The bacteria Streptococcus pneumonia is the most common cause of pneumonia.
Legionella pneumophila is another bacterium that causes legionnaires disease, a type of
pneumonia. Other bacteria that can cause pneumonia include Legionella pneumophila,
Mycoplasma pneumonia and Chlamydophila pneumonia, which are known as "atypical
"pneumonia bacteria.
• Pneumonia can be caused by the bacteria Haemophilus influenza. It is most
commonly found in babies and children under the age of five. Adults 65 and older, as well as
American Indians and Alaska Natives, are at a higher risk of contracting H. influenzae.
• The influenza virus is the most common cause of viral pneumonia in adults.
Pneumonia is caused by a variety of respiratory viruses in children, including respiratory
syncytial virus. While viral pneumonia is less severe than bacterial pneumonia, it does
increase the risk of secondary bacterial pneumonia.
• Influenza Viruses, on the other hand, can cause serious complications in some
patients. Measles and varicella (chickenpox) viruses are two other virus types that can cause
pneumonia. Certain viruses, such as SARS (Severe Acute Respiratory Syndrome) or MERS
(Middle East Respiratory Syndrome), can cause lethal pneumonias in rare cases. Both
disease are caused by different corona viruses.
• Cryptococcus, Histoplasma and Coccidioides are some of the fungi that cause
pneumonia. These organisms do not cause illness in most people, but they can cause
pneumonia in some. Fungal infections are most common in people who have weakened
immune system as a result of HIV/AIDS or who are taking immune-suppressing medications.
Pneumocystis jirovecii, formerly known as Pneumocystis carinil, is another type of
pneumonia.

• Risk factors:
• Old age
• Immobility of any cause
• Chronic Diseases
• Immunosuppression
• Alcoholism
• Malnutrition
• Crowded living conditions
• Specific medications

• Clinical Manifestation
• Pneumonia symptoms vary, ranging from mild to severe enough to necessitate
hospitalization. The type of germ that causes the infection, age and overall health all
influence how the body reacts to pneumonia.
• The following are some of the sign and symptoms of pneumonia:
1. Coughing (greenish, yellow or even bloody mucus).
2. Fever, sweating and shivering chills.
3. Breathing problem.
4. Breathing that is quick and shallow.
5. Sharp or stabbing chest pain that worsens when a person coughs or breathes deeply.
6. Appetite loss, low energy, and exhaustion.
7. Especially in small children, nausea and vomiting are common.
8. Confusion, especially among the elderly.

• Non-pharmacological Management
1. Quit smoking
2. Maintain a healthy level of hygiene.
3. Keep yourself well rested and in shape.
4.The use of surgical masks by the sick is strongly advised.
5.Drink plenty of fluids, especially water, to aid in the loosening of pulmonary mucus.

• Pharmacological Management
1. Vaccination:- Currently, there are three vaccines available that can significantly reduce
childhood mortality from and related to pneumonia. These are:
i. Pneumococcal Conjugate Vaccine
ii. Hib-containing pentavalent vaccine (hib-Haemophilus influenzae type b)
iii. Measles vaccine.
• The pneumonia vaccines available for adults are:- Pneumovax(PPSV23)& Prevnar(PCV13)
2. Drug therapy:- Most cases of viral pneumonia are self -limiting, although therapy of
influenza pneumonia with specific antiviral agents such as amantadine or rimantadine may
spread up recovery.
• Treatment of bacterial pneumonia, initially involves empiric antibiotic therapy based
on severity and patient risk factors.
• Also supportive care should be provided to treat pneumonia.

• Supportive therapy may include

1. Sufficient rest and physical therapy
2. Hydration
3.Treat hypoxemia
4.Incentive spirometer
5.Antipyretics, analgesics as needed (e.g.,paracetamol)
6.Expectorants and mucolytics
7.Antitussives(e.g.codein)

• Drug to treat pneumonia

i) Macrolide antibiotics:- eg. Clarithromycin, Azithromycin.
ii) Fluroquinolones:- eg. Levofloxacin, Ciprofloxacin.
iii) Tetracyclines:- eg. Tetracycline, Doxycycline.

3. Urinary Tract Infection

• Urinary tract infections (UTIs) are infections of the urinary system that includes
urethra, bladder, ureters, and kidneys. UTIs are most commonly caused by bacteria,
especially E.Coli.
• Urinary tract infections represent a wide variety of syndromes, including urethritis,
cystitis, prostatitis, and pyelonephritis.
• Urethritis is infection and inflammation of the urethra.
• Cystitis is infection and inflammation of the urinary bladder.
 • Prostatitis is inflammation of the prostate gland. It may be due to infection of the
prostate gland.
• Pyelonephritis is the inflammation of the kidney due to a bacterial infection.
• Ureteritis is the inflammation of the ureter and is rare. It is often associated with cystitis
or pyelonephritis.

• Etiopathogenesis
• Bacteria enter the urinary tract through the urethra and multiply in the bladder,
resulting in a UTI. Despite the fact that the urinary system is designed to keep such
microscopic pathogens out, the defenses occasionally fail. Bacteria may take hold and grow
into a fullblown infection in the urinary tract if this happens.
• The bladder and urethra are the most common sites for UTIs in women.
• Infection of the bladder(cystitis) :Escherichia coli(E.coli), a type of bacteria commonly
found in the gastrointestinal tract, is the most common cause of this type of UTI. Other
bacteria, on the other hand, are sometimes to blame. Cystitis can be cause by sexual
activity. Because of the short distance between the urethra and the anus, and the urethral
opening to the bladder, all women are at risk of cystitis.
• Urethritis (Urethral infection) :- This type of UTI occurs when bacteria from the
anus spread to the urethra. Sexually transmitted infection like herpes, gonorrhea, chlamydia,
and mycoplasma can cause urethritis bacause the female urethra is so close to the vagina.

• Risk Factors for urinary tract infection :

• Shorter urethra of females
• Sexual intercourse
• Certain type of birth control measure e. g.diaphragms, spermicidal creams
• Menopause
• Urinary tract abnormalities e.g. congenital defects
• Blockages in the urinary tract e.g.urinary calculli
• A suppressed immune system
• Use of urinary catheters
• A recent urinary procedure e.g.surgery
• Delayed post-coital micturition

• Complication in UTI may include:

1. Recurrent infection
2. It may cause permanent kidney damage.
3. Increased risk in pregnant women of delivering premature infants.
4. Urethral narrowing in men.
5. Urosepsis

• Clinical Manifestation
1. Dysuria (Painful urination)
2. Suprapubic tenderness
3. Increased urinary urgency
4. Increased urinary frequency
5. Hematuria
6. Chills
7. Fever
8. Flank pain
9. Costovertebral angle tenderness
10. Fatigue/malaise
11. Nausea and vomitting
12. Signs of sepsis:- Hypotension, temperature>40°C etc.
13. Burning with urination
14. Pelvic pain is a common complaint among women.

• Non-pharmacological Management
1. Drink plenty of water
2. Avoid drinks that may irritate bladder.
3. Using a heating pad may help to reduce pain in the abdomen or lower back.
4. Maintain hygiene
5. Avoid potentially irritating feminine products.
6. Make sure you are getting enough vitamin C.
7. Cranberry juice should be consumed.
8. Wipe the entire surface from front to back.
9. Keep vourself hydrated.
10. Probiotics should be used.
11. Maintain proper sexual hygiene.

• Pharmacological Management
i) Antibiotics:- eg. Nalidixic acid, fosfomycin, Nitrofurantoin, Ciprofloxacin,
Trimethoprim/Sulfamethoxazole, Levofloxacin, Methenamine Hippurate, Cephalexin.
ii) Pain relievers:- eg. Phenazopyridine.