Infections disease

1. Prepared by
Ms. Gunjegaonkar M.B.
SJVPM’S Rasiklal M. Dhariwal College of Pharmacy

2. After studying this unit student will be able to
» Understand about various infectious diseases, their signs and symptoms
» Explain the pathophysiology of infectious diseases
» Understand rational use of medicine in infectious diseases
» Provide well planned procedures of management of infectious diseases.

3. Infectious diseases are illnesses caused by harmful agents (pathogens) that
get enter into your body. The most common causes are viruses, bacteria,
fungi and parasites. Infectious diseases most often spread from one person
to another person, through contaminated food or water and through bug
bites. Some infectious diseases are minor and some are very serious.
Infectious diseases can be caused by;
» Bacteria: Bacteria may cause infections such as Tuberculosis, Urinary Tract
Infection.
» Viruses: Viruses can cause diseases like common cold, SARS, CoV2, AIDS
etc.
» Fungi: Many skin diseases such as Athlete’s foot, ringworm, yeast infection
etc.

4. Introduction
Infectious diseases are illnesses caused by harmful agents (pathogens) that get enter into
your body. The most common causes are viruses, bacteria, fungi and parasites. Infectious
diseases most often spread from one person to another person, through contaminated
food or water and through bug bites. Some infectious diseases are minor and some are
very serious. Infectious diseases can be caused by;
» Bacteria: Bacteria may cause infections such as Tuberculosis, Urinary Tract Infection.
» Viruses: Viruses can cause diseases like common cold, SARS, CoV2, AIDS etc.
» Fungi: Many skin diseases such as Athlete’s foot, ringworm, yeast infection etc.

5. » UTIs, the second-ranked infectious diseases, are recognized as a
big concern relating to global healthcare systems. Moreover,
UTIs are known as multi-microbial infectious diseases, which
can be happened by bacteria (Gram-positive and/or Gram-
negative strains) and fungi.
» A urinary tract infection is what happens when bacteria (germs)
get into the urinary tract (the bladder) and multiply. The result
is redness, swelling and pain in the urinary tract.
» Definition-
» A urinary tract infection (UTI) is an infection from microbes.
These are organisms that are too small to be seen without a
microscope. Most UTIs are caused by bacteria, but some are
caused by fungi and in rare cases by viruses.
» Urinary Tract- A UTI can happen anywhere in our urinary tract.
Our urinary tract is made up of kidneys, ureters, bladder, and
urethra. Most UTIs only involve the urethra and bladder, in the
lower tract. However, UTIs can involve the ureters and kidneys,
in the upper tract. Although upper tract UTIs are more rare than
lower tract UTIs, they’re also usually more severe.

6. » There are different types of UTIs including acute and/or chronic, asymptomatic
and/or symptomatic (mild/moderate and/or severe), complicated and/or
uncomplicated, and community and/or nosocomial acquired infections. If the UTIs
occur ≥ three times in a year or ≥ two times continuously after disappearance
(treatment) of the first infection in a half year, they are recognized as recurrent UTIs
(rUTIs). In addition to this diversity, as the human’s urinary tract (UT) is divided into
two parts of lower and upper sections, the UTIs may occur in the lower part of the
UT (known as cystitis) and/or pelvis and parenchyma of the kidney upper part of the
UT (known as pyelonephritis).
» Hospitalization is one of the significant factors associated with UTIs which results in
secondary bacteremia. Normally, hospitalization and catheterization are important
predisposed factors to nosocomial UTIs because the use of catheters (e.g., bladder
catheter) may occur during hospitalization which results in UTIs.
» Symptoms of a UTI depend on what part of the urinary tract is infected;

7. Lower Urinary Tract Infection Upper Urinary Tract Infection
Increased frequency of urination without passing
much urine
Pain and tenderness in the upper back
and sides
Burning with urination Chills with unusual headache
Increased urgency of urination Fever which follow come and go pattern
Bloody urine Nausea
Cloudy urine Vomiting
Urine that looks like cola or tea, Urine that has a
strong odor, Pelvic pain in women, Rectal pain in
men

8. Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to
multiply in the bladder. Although the urinary system is designed to keep out such
Microscopic invaders, these defense sometimes fail. When that happens, bacteria may take hold and grow into a
full-blown infection in the urinary tract. Host factors, including age, diabetes, spinal cord injury, or
catheterization, have a significant impact on the etiology of UTIs.
Etiology:
Cause of UTI Description
Female anatomy A woman has a shorter urethra than a man does, which
shortens the distance that bacteria must travel to reach
thebladder.
Certain types of birth control Women who use diaphragms for birth control may be at
higher risk, as well as women who use spermicidal agents.
Menopause After menopause, a decline in circulating estrogen causes
changes in the urinary tract that make you more

9. Etiology:
Cause of urinary tract
infection
Description
Menopause After menopause, a decline in circulating estrogen causes
changes in the urinary tract that make you more
vulnerable to infection
Infection of the bladder
(cystitis)
This type of UTI is usually caused by Escherichia coli a type
of bacteria commonly found in the GIT.
Infection of the urethra
(Urethritis)
This type of UTI can occur when GI bacteria spread from
the anus to the urethra. Also, because the female urethra
is close to the vagina, sexually transmitted infections, such
as herpes, Gonorrhoea, can cause Urethritis.

10. Etiology:
Cause of UTI Description
Blockages in the urinary tract Kidney stones or an enlarged prostate can trap urine in the
bladder and increase the risk of UTIs.
A suppressed immune
system
Diabetes and other diseases that impair the immune
system —
the body's defense against germs — can increase the risk
of UTIs.
Catheter use (Nosocomial
UTIs/Hospital Acquired
Infections)
People who can't urinate on their own and use a tube
(catheter) to urinate have an increased risk of UTIs

11. Molecular techniques (e.g., polymerase chain reaction (PCR)
Urine Culture
Ultrasound
Cystoscopy
CT Scan
Advanced pan-genomic tools (e.g., microarray technology)
Urinary tract infections and diagnostics:

12. Non Pharmacological Management of Urinary Tract Infection:
1. Drink plenty of liquids, especially water.
Drinking water helps dilute your urine and ensures that you'll urinate more frequently
allowing bacteria to be flushed from your urinary tract before an infection can begin.
2. Drink cranberry juice.
Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not
harmful.
3. Wipe from front to back.
Doing so after urinating and after a bowel movement helps prevent bacteria in the anal
region from spreading to the vagina and urethra.
4. Empty your bladder soon after intercourse. Also, drink a full glass of water to help
flush bacteria.
5. Avoid potentially irritating feminine products. Using deodorant sprays or other
feminine products, such as douches and powders, in the genital area can irritate the
urethra.

13. Pharmacological Management of Urinary Tract Infection
A. Antibiotic therapy for urinary tract infections;
Fluroquinolones: Norfloxacin, Ciprofloxacin HCl, Levofloxacin etc.
Nitrofurantoin: Nitrofurantoin is available in two formulations, the macro crystalline
formulation (Macrodantin) and the monohydrate-macrocrystal form (Macrobid)
Β-Lactams: Cefpodoxime, Cefixime, Cephalexin, Amoxicillin etc.
B. Trimethoprim-sulfamethoxazole: For acute and recurrent urinary tract infections
because of its activity against the most common uropathogens.

14. Hepatitis
Introduction to Hepatitis:
It is a systemic and viral infection, in which the inflammation of liver cells and necrosis occurs. Hepatitis means the
"inflammation of liver". The most important leading cause is viruses. Alcoholic drinks, medicines, poisons and genetic
diseases also cause hepatitis. It may be acute (recent infection, relatively rapid onset) or chronic.
Causative organisms: The most common causes of viral hepatitis are five hepatotropic viral agents;
• Hepatitis A virus (HAV)
• Hepatitis B virus (HBV)
• Hepatitis C virus (HCV)
• HBV-associated delta agent or hepatitis D virus (HDV) and
• Hepatitis E virus (HEV)
The virus is usually transmitted by the faecal–oral route through person-to- person transfer or contaminated food or
drink. The incubation period is usually around 28–30 days but may occasionally be as short as 15 or as long as 50 days.

15. Etiopathogenesis of Hepatitis
Features Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Causative
Agent
Hepatitis A
virus (HAV)
enterovirus,.
Hepatitis B virus
(HBV) RNA virus
Hepatitis C virus
(HCV)
Hepatitis D virus
(HDV) Defective
RNA virus
Hepatitis E
virus (HEV)
Family picornaviridae hepadnaviridae Flaviviridae Kolmioviridae Hepevirus
Mode of
transmission
Faecal or oral
route
Parenteral
route
Sexual
Transmission
Parenteral
route
Sexual
Transmission
Prenatal
transmission
Blood sucking
arthropods
Parenteral
transmission
Sexual
transmission
Perinatal
transmission
transplantation of
organs from
infected donors
exposure to
infected blood
products
percutaneous or
sexual routes.
sharing of
contaminated
needles among IV
drug abusers.
fecal-oral
route
Incubation
period
30 days 60-90 days 50 days 60-90 days 40 days
Onset Acute Insidious Acute Insidious Acute
Age Child & young Young adults Any age Any age Young adults
Severity Mild May be severe Moderate severe Mild
Fulminant 0.1 % 0.1 -1% 0.1% 5-20% 1-2%
Chronicity None 1-10% 85% Common None

16. Hepatitis A Pathogenesis:
Fecal-oral transmission
Viral replication in the liver
Virus present in blood and feces 10 to 12 days after infection
Virus excretion may continue for up to 3 weeks after onset of symptoms

17. 8.5.3 Clinical Manifestation:
1. Fatigue
2. Malaise
3. Nausea & vomiting
4. Anorexia
5. Fever
6. Abdominal discomfort
7. Light color stool and dark urine.
8. Loss of appetite
9. Jaundice: Yellowing of the skin
10. Right upper quadrant pain
11. Rash and joint pain

18. 8.5.4 Diagnosis
1. Liver Function Test : Billirubin, SGPT
2. Prothrombin Time: Prolonged
3. Hyperglobulinemia
4. Alkaline phosphatase: mildly increased
5. Serological markers : Total (IgG and IgM) antibody
6. Molecular virology methods such as polymerase chain reaction
7. (PCR)-based assays can be used to amplify and sequence viral genomes

19. 8.5.5 Non pharmacological Management of
Hepatitis
Reduce the spread of infection by;
Personal and community hygiene like, hand
washing after toilet and before meals
Sanitary disposal of excreta
Safe water supply and
Proper sterilization of needles and syringes.
Vaccination:
HepA (Havrix, Vaqta)
HepA-HepB (Twinrix)

20. Pharmacological Management of Hepatitis
HEPATITIS A:
As the disease is usually self-limited, the treatment is supportive, Rest is suggested
according to patient’s level of fatigue.
Patients rarely require hospitalization except for those who develop acute hepatic
failure.
If Hospitalization is required;
Small, frequent feedings of a high calorie, low fat diet, proteins are restricted.
Vit. K injection if Prothrombin Time is prolonged.
I.V. fluid and electrolyte replacement.
Antiemetic drugs.

21. HEPATITIS B:
Treatment of acute hepatitis B is indicated only in patients with severe hepatitis and liver
failure. Rest, use of vitamin supplements is recommended, Avoid alcohol.
Treatment of chronic hepatitis B : There are various antiviral agents recommended for
treatment of CHB. The section below shows with these drugs and their dosages in adults and
children.
Nucleoside and Nucleotide analog such as Tenofovir, adenofovir, lamivudine.
Lamivudine (Epivir) -an antiviral agent. -have shown improved seroconversion rates, improved
liver function, and reduced progression to cirrhosis -it can be used for patients who are
awaiting liver transplantation. Adenofovir (Hepsera) -an antival agent. -may be effective in
people who are resistant to lamivudine.
Antacids and Antiemetics -measures to control the dyspeptic symptoms and general malaise.
Sr.N
o.
Name of the drug Drug Dose
1 Tenofovir disoproxil fumarate (TDF) 300 mg daily once
2 Entecavir (adult with compensated liver disease &
lamivudine naive)
0.5 mg once daily
3 Entecavir ( adult with decompensated liver disease) 1 mg once daily
4 Tenofovir alafenamide fumarate ( TAF) 25 mg once daily

22. HEPATITIS C:
In a patient with acute hepatitis C treatment with Pegylated interferon within the 12-24
weeks of infection reduce the development of chronic hepatitis C.
For Chronic HCV: Pegylated interferon, Ribavirin Rebetol, Protease inhibitors such as
incivek and Boceprevir are used.
HEPATITIS D:
Pegylated interferon alpha is the recommended treatment for hepatitis D virus infection.
Treatment should last for at least 48 weeks irrespective of the patient’s response.
HEPATITIS E:
There is no specific treatment capable of altering the course of acute hepatitis E.
As the disease is usually self-limiting, hospitalization is generally not required.
Hospitalization is required for people with Fulminant hepatitis.

23. Gonorrhea
Gonorrhea is a sexually transmitted disease (STD). The causative organism is
Neisseria gonorrhoeae, the gram‐negative diplococcus bacteria. N. gonorrhoeae
infects the mucous membranes of the reproductive tract, including the cervix,
uterus, and fallopian tubes in women, and the urethra in women and men. N.
gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes,
and rectum. The organism may also cause local or metastatic complications.
Synonyms of Gonorrhea;
1. Pelvic inflammatory disease (PID)
2. Sexually transmitted disease (STD)
3. Sexually transmitted infection (STI)

24. Depending on anatomic location, gonorrhea may be classified into three subtypes: urogenital,
extra genital and disseminated gonococcal infection. Apart from this, gonococcal infections
may be classified into many subtypes according to the affected organ system;
1. Urogenital infection
Urogenital infection in women
Urogenital infection in men
2. Extragenital infection
Proctitis: Proctitis is inflammation of the lining of the rectum.
Pharyngitis: An inflammation of the pharynx, resulting in a sore throat.
Conjunctivitis: It is the inflammation or infection of the transparent membrane that lines
eyelid and eyeball.
3. Disseminated gonococcal infection (DGI): DGI is an uncommon, but severe,
complication of untreated gonorrhea. DGI occurs when the sexually transmitted pathogen
Neisseria gonorrhoeae spreads into the bloodstream and to distant sites in the body, may lead
to effects such as septic arthritis, polyarthralgia, petechial/pustular skin lesions, bacteremia,
or, on rare occasions, endocarditis or meningitis.

25. Etiopathogenesis of gonorrhea:
N. gonorrhoeae, a Gram‐negative diplococcus, may infect the mucosal
surfaces of urogenital sites (e.g., cervix, urethra, and rectum) and the
oropharynx and nasopharynx (i.e., throat), leading to symptomatic or
asymptomatic infections. The incubation period for gonorrhea is usually 2-7
days after exposure to an infected partner.
Gonorrhea is efficiently transmitted by;
Sexual contact
Male to female via semen
Female to male urethra
Anal intercourse
Oro-genital sex (pharyngeal infection)
Peri-natal transmission (mother to infant): Ophthalmia neonatorum

26. Pathogenesis of gonorrhea:
Primary infection begins at the columnar epithelium of urethra & Peri
urethral gland. Also in endocervix, rectal mucosa & conjunctiva.
After contact, bacteria attach to epithelial cells of host by pili.
Then pass between the epithelial cells & goes to submucosa & multiply.
As a result Immune response, manifested by inflammatory exudates with
infiltration of huge number of neutrophil & pus cell.
From primary site they spread upward to involve the other sides of the body
& causes lesions and spreads the infection

27. Clinical Manifestations of Gonorrhea:
Gonorrhea Symptoms in Men: Many men with gonorrhea are asymptomatic.
White, yellow or green thick discharge from the tip of the penis
Inflammation of the testicles & prostate gland
Irritation or discharge from the anus
Urethral itch & pain or burning sensation when passing urine
Gonorrhea Symptoms in Women;
Strong smelling vaginal discharge-thin & watery/ thick & yellow/green
Irritation or discharge from the anus
Abnormal vaginal bleeding
Low abdominal or pelvic tenderness
Pain or a burning sensation when passing urine
Low abdominal pain sometimes with nausea
Pelvis inflammation may occur if gonorrhea is untreated and it may leads to infertility,
sterility or ectopic pregnancy.
Gonorrhea can spread from the original site of infection and infect and may damage the
joints, skin, and other organs, if it remains untreated. Resulting in fever, skin rashes, sores,
and joint pain and swelling etc.

28. Diagnosis of Gonorrhea:
Diagnosis is based on a combination of history, physical examination and laboratory
investigation. Samples can be collected by:
Urine test: This can help to identify bacteria in urethra.
Swab of affected area. A swab of throat, urethra, vagina or rectum can be collected
to identify bacteria.
Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or
endocervical or vaginal (for women) specimens using nucleic acid amplification
testing (NAAT).

29. • Non- Pharmacological Management of Gonorrhea:
• To reduce the risk of occurrence of gonorrhea:
• Use of condom during sex: Not having sex is the surest way to prevent gonorrhea. If not
possible correct use of a condom during any type of sexual contact, including anal sex,
oral sex or vaginal sex.
• Limit number of sex partners: Being in a monogamous relationship in which neither
partner has sex with anyone else can lower your risk.
• Test regularly for sexually transmitted infections: Before having sex, both partners should
get tested and share the results with each other.
• Don't have sex with a person with the history of sexually transmitted infection: If your
partner has signs or symptoms of a sexually transmitted infection, such as burning during
urination or a genital rash or sore, don't have sex with that person.
• Regular gonorrhea screening: Annual screening is advised for sexually active women and
for older women at increased risk of infection. Ex. women who have a new sex partner,
more than one sex partner, a sex partner with other partners, or a sex partner who has a
sexually transmitted infection.
• Regular screening is also recommended for men who have sex with men, as well as their
partners.

30. Pharmacological Management of Gonorrhea:
Antibiotics are used for treating gonococcal infections. Because of resistance to penicillins,
cephalosporin, and quinolone antibiotics are typically employed to treat these infections.
Name of the
drug
Details
Cefixime
Cefixime is considered a drug of choice for gonococcal infections. The recommended adult
dose is 400 mg orally once daily.
Ceftriaxone
Ceftriaxone is considered a drug of choice for gonococcal infections. The recommended
adult dose for uncomplicated infection is since dose of 125 mg Intramuscular followed by
100 mg doxycycline orally for 7 days. For serious disseminated infection the recommended
dose is 1 gram ceftriaxone by Intravenous or Intramuscular route daily for 7 days.
Ciprofloxacin
The recommended adult dose of ciprofloxacin is 500 mg orally administered once for the
treatment of this infection.
Ofloxacin
The recommended adult dose of Ofloxacin is 400 mg orally administered once for the
treatment of this infection.
Azithromycin
The recommended adult dose of azithromycin is 2 gm orally administered once for the
treatment of this infection. It is not generally recommended because of its cost and