UNIVERSITY OF CAPE COAST

COLLEGE OF HEALTH AND ALLIED SCIENCES

SCHOOL OF MEDICAL SCIENCES

PHYSICIAN ASSISTAB PROGRAM

PHA 308 INTERNAL MEDICINE

(BACTERIA)
NAMES INDEX NUMBERS

ABAKISI GLORIA AH/PAS/21/0076

ADJEI JEMIMA SERWAA AH/PAS/21/0046

ARMAH ABEDI AH/PAS/22/0137

IDDI THOMAS SELEMAN DAWUNI AH/PAS/21/0062

ACKAH, JOSEPHINE JESSICA AH/PAS/21/0070

NTUMY NATHANIEL AH/PAS/20/0107

ASARE GIFTY AH/PAS/21/0073

ADJEI LORRAINE OKAE AH/PAS/22/0114

AGYEI DANIEL AH/PAS/22/0159

 OUTLINE
 DEFINITION
 Classifivcation
 Epidemeology
 Etiology
 Symptoms and signgs
 Ivestigations
 Prognosis
 Complications
 Introduction
what is a bacteria?
A bacterium (plural: bacteria) is a type of microscopic single-celled organism that lacks a
distinct nucleus and membrane-bound organelles.
Bacteria are prokaryotes, meaning their genetic
material (DNA) is not enclosed within a nucleus.

They are diverse in shape and size, and can be found

virtually everywhere on Earth, from soil and water to
inside the human body.

Bacteria play crucial roles in various ecological processes, such as nutrient cycling, and
can have both beneficial and harmful effects on other organisms, including humans.
 Cocci (singular: coccus): Spherical or round-shaped bacteria. Examples include
Streptococcus and Staphylococcus.
 Bacilli (singular: bacillus): Rod-shaped bacteria. Examples include Escherichia
coli (E. coli) and Bacillus subtilis. Spirilla (singular: spirillum):
 Spiral-shaped bacteria with a rigid helical shape. Examples include Spirillum and
Campylobacter.
 Filamentous: Bacteria that form long filaments or chains. Examples include
Actinobacteria like Streptomyces. Pleomorphic: Bacteria that can vary in shape.
They may appear differently under different conditions. Examples include
Mycoplasma.

What forms do bacteria exist?

Bacteria exist in various forms, primarily categorized by their shape and
arrangement. Here are the main forms in which bacteria exist:
How do bacteria replicate?
Bacteria replicate or reproduce primarily through two main mechanisms:
 Binary fission: this is the most common method of bacterial reproduction. In binary
fission, a single bacterial cell divides into two identical daughter cells. The process
involves several steps: the bacterial cell elongates and its DNA replicates.
 The dna copies move to opposite ends (poles) of the cell. The cell wall and membrane then
grow inward, eventually dividing the cell into two daughter cells, each with a complete set
of genetic material.
 Budding: some bacteria reproduce through budding, where a small new cell develops from
the surface of the parent cell. The newly formed bud grows until it detaches from the
parent cell, T t becoming an independent bacterium.
EPIDEMIOLOGY
Examples of tropical/developing countries that are burdened with bacterial infections india,
nigeria, pakistan, bangladesh, ethiopia, haiti, democratic republic of congo,kenya in tropical
and developing countries, bacterial infections contribute significantly to mortality rates,
especially among children under five. Diseases like pneumonia, tuberculosis, and diarrheal
diseases (often bacterial in origin) are leading causes of death.
The epidemiology of bacterial infections in developing and tropical countries is influenced by
several factors that differ from those in developed nations. Below are some key points:
pathogen diversity: tropical regions often have a higher diversity of bacterial pathogens due to
varied ecological conditions and interactions between humans, animals, and the environment.

This diversity can complicate diagnosis and treatment. Water and sanitation: poor access to
clean water and sanitation facilities contributes significantly to the burden of bacterial
infections in developing countries. Waterborne diseases like cholera and typhoid fever are more
prevalent under these conditions.

Vaccine access: limited access to vaccines against bacterial infections (e.G., Pneumococcus,
meningococcus) contributes to higher disease burdens in developing countries.Socioeconomic
factors: poverty, lack of education, and cultural practices can influence healthcare-seeking
behaviors and the transmission dynamics of bacterial infections.Crowded living conditions:
urbanization and population density in developing countries can facilitate the spread of
bacterial infections, particularly those transmitted through respiratory droplets or close contact.
 Typhoid fever
 , also known as enteric fever, is a systemic infection caused by the bacterium Salmonella enterica
serotype Typhi. It is a significant public health concern in developing countries, particularly in areas
with poor sanitation and limited access to clean water.
Causes:
 Typhoid fever is primarily spread through contaminated food and water, as well as direct contact with an
infected person. The bacteria multiply in the intestine and are then absorbed into the bloodstream,
leading to systemic infection.

Signs and symptoms:

The most common symptoms of typhoid fever include sustained fever, fatigue, headache,
abdominal pain, and constipation or diarrhea.

Patients may also experience a rash, enlarged spleen, and rose-colored spots on the chest
and abdomen. In severe cases, complications such as intestinal perforation or encephalitis
can occur.
 Investigations:
 Diagnosis of typhoid fever is usually confirmed through a combination of blood, urine,
and stool tests. Blood cultures are the gold standard for diagnosis, as they can detect the
presence of Salmonella typhi bacteria in the bloodstream.
Treatment
 antibiotics such as ciprofloxacin or ceftriaxone are typically used to treat typhoid fever
and reduce the duration and severity of symptoms.
 Adequate hydration and nutritional support are also essential for managing the illness. In
severe cases, hospitalization may be necessary to monitor for complications and ensure
timely intervention.

Prevention:
Preventive measures for typhoid fever include practicing good hygiene, ensuring access
to safe drinking water, and getting vaccinated before traveling to high-risk areas. The
typhoid vaccine is recommended for individuals at risk of exposure, such as travelers to
endemic regions or individuals in close contact with infected persons.
 Tetanus
Acute exotoxin mediated infection cause by anaerobic spore forming,gram negative
bacillus clostridium tetani.These bacterium live predominantly in the soil, so it is easy to get
this infection when ever a break in the skin is not properly cleaned.
Incidence
1. World wide
2. Prevalent in agricultural regions
3. Common in developing countries that lacks mass immunization
4. Prevalent in women
5. High mortality rate, with death occuring in over 40% of all cases
Causes
Clostridium tetani, Mode of transmission is through punctured wound contaminated by
soil, dust, or human/animal excreta

INCUBATION PERIOD : 8-12 DAYS

Pathophysiology
When Clostridium tetani spores enter the body, they can germinate and produce
tetanospasmin, a potent neurotoxin. This toxin interferes with neurotransmitter release,
particularly inhibiting the release of inhibitory neurosmitters, leading to unopposed
muscle contractions and spasms.
Classification
Tetanus can be classified into four types:

• generalized tetanus: the most common form, affecting multiple muscle groups.

• Localized tetanus: limited to the muscles around the wound.

• Cephalic tetanus: associated with head wounds, leading to facial muscle involvement.

• Neonatal tetanus: it's the tetanus that affects a newborn. Infection is usually via the
umbilical cord if not kept clean or non sterilised instruments or dressings are used.
 Symptoms
•Stiff body
•Baby can't suck
•Constipation •Spasms
Signs
• umbilicus may be infected
•irritability
• blue(cynosed )tongue and lips during spasms
• sardonic smile (mocking smile)
• lock jaw(can't open mouth)
• opisthotonos (stiff arched back)
• rigid abdomen
• Painful muscle contractions, particularly in the back, neck, and abdomen
• photophobia
INVESTIGATION
•No confirmatory test Clinical Diagnosis: Based on history of wound and characteristic
symptoms.
NON PHARMACOLOGICAL TREATMENT
• Maintain a clear airway
• Avoid noise, bright light and unnecessary examination of the patient
• Clean the infected Umbilicus or wound with soap and water or antiseptic solution
• Surgical debridement of wound
PHARMACOLOGICAL TREATMENT
antibiotics: metronidazole or benzylpenicillin, gentamicin , erythromycin to kill the
bacteria.
Tetanus immunoglobulin (TIG): neutralizes the toxin(150unit/kg) tetanus toxoid
vaccination: to induce active immunity.
Muscle relaxants and sedatives: to manage muscle spasms. Eg chlorpromazine,
diazepam, phenobarbital (phenobarbitone)
PREVENTION
To prevent tetanus in patients with potentially contaminated wound(tetanus prone)
•Provide adequate wound toileting
• Provide tetanus prophylaxis
• Use sterilised instruments and in cutting umbilicus and sterilised dressing • clean
umbilical cord with methylated spirit or chlorhexidine gel (best choice now)

COMPLICATIONS
• respiratory failure due to spasms of the respiratory muscles.
• Bone fractures from intense muscle spasms.
•Hypertension and cardiac arrhythmias.
• Nosocomial infections from prolonged hospitalization.
• Long-term disability due to prolonged muscle contractions and spasms
Diphtheria
It is a serious bacterial infection that usually affects the
mucous membranes of the nose and throat.
It is caused by the toxigenic strain of
corynbacterium diptheraie.

TYPES
respiratory and cutaneous

transmission| the primary modes of spread consist of close contact with infectious
material from respiratory secretions (direct or via airborne droplet) from skin lesions.
Humans are believed to be the only known reservoir for C. Diphtheriae, although rare
cases of disease in animals have been reported infection may occur throughout the year
with a peak incidence in the colder months.
Pathophysiology
The bacteria upon colonization rapidly multiply on the surface of mucous membrane of the
throat where they cause inflammation. The inflammation may spread to the larynx(voice
box) which may cause the throat to swell resulting in obstruction of the airway. The
organism also releases a damaging toxin which can affect the heart, brain and
nerves( hematogenous spread).

Signs and symptoms ( respiratory diptheria)

incubation is 2 to 5 days
sore throat
hoarseness
dysphagia and throat pain
 Swollen lymph nodes of the neck a thick gray membrane covering the throat and tonsils
Dyspnea, fever and chills, weakness and fatigue/ .
Cutaneous diptheria found in people with poor personal hygiene. Any break in can become
infected with diptheria and result in an ulcer with a gray membrane covering it.

Diagnosis
Physical examination
Full blood count
Throat swab
Management
Isolation
Antibiotics (penicillin or erythromycin)
Paracetamol (analgesic and antipyretic) and vitamin c
Fluid diet should be given with more fluids
Complications
 injury to heart muscles
 (cardiomyopathy)
 injury to nerves (neuropathy)
 Paralysis

Prevention
 Vaccination (given 6,10 and 14 weeks of age or confirming absence of organism with
labs after treatment)
 maintenance of personal and environmental hygiene
 Wearing of facemask
Cholera
Cholea is caused by the curved, flagellated, gram- negative bacillus, vibrio cholera, which
is characterized by severe, watery diarrhea and vomiting the organism is killed by
temperatures of 100°C in a few seconds but can survive in ice for up to 6 weeks.

Aetiology
A bacterium called vibrio cholerae causes cholera infection. The deadly effects of the
disease are the result of a toxin the bacteria produces in the small intestine. The toxin
causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid
loss of fluids and salts (electrolytes).
1. Cholera Toxin (CT): - Cholera toxin is the primary virulence factor of Vibrio cholerae.
- It is an AB5 type toxin, consisting of a single A subunit and five B subunits.
- The B subunits bind to the GM1 ganglioside receptors on the intestinal epithelial cells,
allowing the A subunit to enter the cell.
- Inside the cell, the A subunit activates the adenylate cyclase enzyme, leading to an increase in
intracellular cAMP levels.
- Elevated cAMP levels result in the opening of chloride channels and inhibition of sodium-
coupled chloride absorption, causing an efflux of water and electrolytes into the intestinal
lumen.
- - This loss of fluids and electrolytes leads to the characteristic profuse, watery diarrhea seen
in cholera patients.
 2. Accessory Toxins:
- Vibrio cholerae also produces additional toxins that contribute to the pathogenesis of
cholera, although to a lesser extent compared to the cholera toxin.
- Accessory toxins include:
- Hemolysin (HlyA): Damages intestinal epithelial cells, contributing to diarrhea.
- Zona Occludens Toxin (Zot): Disrupts the tight junctions between intestinal epithelial
cells, increasing permeability and fluid loss.
- - Accessory Cholera Enterotoxin (Ace): Induces secretion of chloride and water into the
intestinal lumen. The combination of the primary cholera toxin and the accessory toxins
produced by Vibrio cholerae leads to the characteristic clinical manifestations of
cholera, including the profuse, watery diarrhea that can result in severe dehydration and
electrolyte imbalances if not promptly treated.
Clinical manifestation early symptoms
 Diarrhoea
 vomiting

late signs and symptoms

 Cold clammy skin,
 Tachycardia,
 hypotension
 Peripheral cyanosis
 Dhydration (sunken eyes, hollow cheeks and a diminished urine output)
 Muscle cramps may be severe.
 Children may present with convulsions owing to hypoglycaemia.
Investigations
Stool culture: Definitive diagnosis of cholera is based on culture of the organism from a
clinical sample (such as stool or rectal swab). V. cholerae can be isolated from stool using
selective media such as thiosulfate citrate bile sucrose agar or taurocholate tellurite gelatin
agar.
Management
 Good personal hygiene
 Proper sanitation
Cellulitis
Definition: Cellulitis is a skin infection affecting deeper layers of the skin and the
underlying tissue caused by bacteria. It specifically affects the dermis and subcutaneous fat.
The bacteria most commonly involved are streptococci and Staphylococcus aureus.
Pathogenesis
It typically enters through cuts, scrapes, abrasions or breaks in the skin. This break does not
need to be visible.

Risk factors
It includes obesity and old age.
The elderly and those with a weakened immune system are especially vulnerable to
contracting cellulitis.
Diabetics are more susceptible to cellulitis than the general population because of impairment
of the immune system;
Symptoms:
 Redness,
 swelling,
 warmth, and
 Pain in the affected area.
Diagnosis
Cellulitis is most often a clinical diagnosis, readily identified in many people by history and
physical examination alone, with rapidly spreading areas of cutaneous swelling, redness, and
heat. Investigation
-Skin aspiration of nonpurulent cellulitis, usually caused by streptococcal organisms, is rarely
helpful for diagnosis
-Blood culture
Treatment:
Eleavating the infected area may be useful.
Treatment is typically with antibiotics taken by mouth, such as cephalexin, amoxicillin, or
cloxacillin.
In those who are seriously allergic to penicillin, erythromycin or clindamycin may be used.
When methicillin-resistant S. aureus (MRSA) is a concern, doxycycline or
trimethoprim/sulfamethoxazole may be used.

Prevention
Good personal hygiene
Proper sanitation
Urinary Tract Infection (UTI)
Definition A urinary tract infection (UTI) is an infection in any part of the urinary system,
including the kidneys, ureters, bladder, and urethra. UTIs are a common type of bacterial
infection, with women being more prone to them than men.

Causes
UTIs are typically caused by bacteria, most often Escherichia coli (E. coli), which
normally live in the bowel. Bacteria can enter the urinary tract through the urethra and
multiply in the bladder, leading to a bladder infection (cystitis). If left untreated, the
infection can spread to the kidneys (pyelonephritis).
Other factors that can increase the risk of developing a UTI include:
 Sexual activity
 Pregnancy - Diabetes
 Urinary tract abnormalities
 Weakened immune system
 Use of certain birth control methods, such as spermicides
 Menopause in women
 Symptoms

The most common symptoms of a UTI include:

 pelvic pain (in women)
 Burning or pain during urination
 Back o r flank pain
 Blood in the urine
 Fever and chills (with a kidney infection)
 Frequent or urgent need to urinate
 Cloudy and foul smelling urine
Diagnosis
To diagnose a UTI, healthcare providers typically perform the following:
Medical history and physical examination
Urine test (urinalysis) to check for signs of infection; presence of white blood cells, red
blood cells, and bacteria in urine
Urine culture to identify the specific bacteria causing the infection : considered the gold
standard for confirming uti diagnosis

Treatment
UTIs are typically treated with antibiotics, which help to kill the bacteria causing the
infection. The specific antibiotic and duration of treatment will depend on the severity of the
infection and the individual patient’s medical history. In some cases, additional treatments
may be necessary, such as pain relievers or medication to relax the bladder.
Examples of antibiotics used are
Ciprofloxacin, trimethoprim,cephalexin
Prevention
To help prevent UTIs, the following measures can be taken:

 Drink plenty of fluids, especially water, to flush out bacteria

 Urinate regularly and completely
 Wipe from front to back after using the bathroom
 Avoid using harsh soaps or feminine hygiene products
 Wear loose, breathable clothing
 Urinate before and after sexual activity
 Taking cranberry supplements
Complications
If left untreated, a UTI can lead to more serious complications, such as:

 Recurring infections
 Kidney infection (pyelonephritis)
 Permanent kidney damage
 Sepsis (a life-threatening infection)
References:

world health organization. (2018).

Typhoid fever. Retrieved from
https://www.Who.Int/en/news-room/fact-sheets/detail/typhoid centers
for disease control and prevention. (2021). Typhoid fever. Retrieved
from https://www.Cdc.Gov/typhoid-fever/index.Html