Epidemiology of some Diseases like Diphtheria, Tuberculosis, Leprosy,Tetanus & Food Poisioning in Brief

1. Epidemiology of Diseases
 Subtitle By,
A. Ajay Kumar Reddy,
B. Pharmacy-III/IV,
Reg No: 13421R0003,
Sri Padmavathi School of Pharmacy.

2. Diseases Caused by Gram ‘+’ Bacteria
Diphtheria,
Tuberculosis,
Leprosy,
Tetanus &
Food Poisoning.
 Introduction
 Study of aetiology,
 Signs & symptoms
 Diagnosis,
 Mode of Transmission,
 Treatment,
 Immunization methods,
 Prevention & Control Methods.

3. Diphtheria
Introdution:
 Diphtheria is an acute, toxin-mediated disease caused by the
bacterium Corynebacterium diphtheriae.
 Greek diphthera=leather hide.
 Described in 5th century BC by Hippocrates,
 First observed by Klebs in 1883 ,

4. Caused By Corynebacterium diphtheriae
Study of aetiology:
Differential Characteristics
 Nonmotile,
 Nonsporing,
 Gram-positive
 Rod Shaped
 Produces Acid From Glucose And Maltose
Fermentation, And No Acid From Sucrose.
 It Is Negative For Urease, Pyrazinamidase, And
Alkaline Phosphatase.
Gram Stain of A Corynebacterium diphtheriae
Stock Culture
Toxin production occurs only when the bacillus is itself infected by
a specific virus carrying the genetic information for the toxin

5. Depending on the anatomic site of disease:
Anterior Nasal
Pharyngeal And Tonsillar
Laryngeal
Cutaneous
Ocular
Genital
Diphtheria Complications :
Most attributable to toxin
Severity generally related to extent of local disease
Most frequent complications are myocarditis and neuritis
Death occurs in 5%-10%

6. Signs and symptoms:
Symptoms of diphtheria include:
 Fever Of 38 °C (100.4 °F) Or Above, Chills, Fatigue,
 Bluish Skin Coloration (Cyanosis),
 Sore Throat,
 Hoarseness,
 Cough,
 Headache,
 Difficulty in Swallowing,
 Difficulty in Breathing,
 Foul-smelling
 Bloodstained Nasal Discharge & Lymphadenopathy.[
 Symptoms Can Also Include Cardiac Arrhythmias,
Myocarditis, And Cranial And Peripheral Nerve Palsies.
Pseudomembrane Covering The Tonsils
A diphtheria skin lesion on the leg

7. Diagnosis:
Diagnosis is made on the basis of clinical presentation of symptoms
Laboratory criteria
1)A Positive Polymerase Chain Reaction Test For Diphtheria Tox Genes, Or
2) Isolation Of C. Diphtheriae from Cultures Of Specimens From Close Contacts, Or
3) A Low Non protective Diphtheria Antibody Titer (Less Than 0.1 IU) In Serum Obtained
Prior To Antitoxin Administration.

8. Mode of Transmission
Spreads by
 Droplet infection (major route)
 Infected cutaneous lessions
 Nasopharyngeal secretions
Portal of Entry
 Mostly by Respiratory tract
 Breeches in skin, eye, genitalia, & middle ear
Incubation Time
2-7 days

9. Treatment
 Tracheotomy
 Diptheria antitoxin
 Metronidazole
 Antibiotics
 Erythromycin Procaine penicillin G (IM14 days)
 Rifampin or clindamycin
Immunization Methods
Diptheria Vaccines are used in combination with Tetanus, Pertusis
4 Types of Diptheria vaccines:
i. DTaP- For infants & children
ii. DT- For infants & children
iii. Tdap- For adolescents and adults
iv. Td- For adolescents and adults

10. Epidemiology
Occurs Worldwide
 Particularly in Tropical countries
 Rare in Industrialised countries(USA)
Occurs mostly in non vaccinated children
Caused several deaths in USA before vaccination
Diphtheria cases reported to the
World Health Organization
About 1 out of 10 people who gets diptheria will die

11. Tuberculosis
Introdution:
 Also called phthisis, phthisis pulmonalis, or consumption
 Phthisis(greek): Consumption
 Infectious disease caused by Mycobacterium tuberculosis
 2 types i) Pulmonary TB
ii)Extra Pulmonary TB
 Tubericulosis bacillus was identified and described by
Robert Koch
 Albert Calmette and Camille Guérin achieved first genuine
success in immunization against tuberculosis

12. Caused By Mycobacterium tuberculosis
Study of aetiology:
Differential Characteristics
 Nonmotile,
 Nonsporing,
 Acid fast,
 Gram-positive ,
 Rod Shaped ,
 Aerobic,
 Divides after 16-20 hours Acid-fast Stain of A Mycobacterium tuberculosis Stock Culture
3 other species which can cause TB
i. Mycobacterium bovis
ii. Mycobacterium aficanum
iii. Mycobacterium microti

13. Signs and symptoms:
Pulmonary TB Extra Pulmonary TB
 Tuberculosis infection becomes active,
 Commonly involves the lungs (90% of cases).,
 Symptoms include i)Chest pain
ii)Prolonged cough producing sputum.
 About 25% of people do not have any symptoms
 Occasionally,
People may cough up blood in small
amounts,
the infection may erode into the pulmonary
artery or a Rasmussen's aneurysm,
resulting in massive bleeding(rarely)
 Notable extrapulmonary infection sites include :
i. Pleura (in tuberculous pleurisy),
ii. The central nervous system (in tuberculous
meningitis),
iii. The lymphatic system (in scrofula of the neck),
iv. The genitourinary system (in urogenital
tuberculosis),
v. The bones and joints (in Pott disease of the spine).
 When it spreads to the bones, it is also known as
"osseous tuberculosis".
 Bursting of a tubercular abscess through skin results
in tuberculous ulcer.
 Potentially more serious, widespread form of TB is
called "disseminated" TB, commonly known as
miliary tuberculosis.

14. Diagnosis:
The Physician will perform a physical exam. This may show:
• Clubbing of the fingers or toes (in people with advanced disease)
• Swollen or tender lymph nodes in the neck or other areas
• Fluid around a lung (pleural effusion)
• Unusual breath sounds (crackles)
Laboratory criteria
• Biopsy of the affected tissue (done rarely)
• Bronchoscopy
• Chest CT scan
• Chest x-ray
• Interferon-gamma release blood test, such as the QFT-Gold test to test for TB
infection
• Sputum examination and cultures
• Thoracentesis
• Tuberculin skin test (also called a PPD test)

15. Mode of Transmission
People with active pulmonary TB
•Cough,
•Sneeze,
•Speak,
•Sing, or
•Spit.
Prolonged, frequent, or close contact with people with TB (22% infection rate)
Probability of transmission from one to another depends upon
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.
}Expel infectious aerosol
droplets 0.5 to 5.0 µm in
diameter

16. Treatment
Antibiotics are mostly used to kill the bacteria
Latent TB- Single antibiotic
Active TB- Combiantion of several antibiotics
In multiple drug-resistant TB-Bedaquiline
Immunization Methods
Only available vaccine is Bacillus Calmette-Guérin (BCG).
In children it decreases the risk of getting infection by 20% and
the risk of infection turning into disease by nearly 60%.
Most widely used vaccine worldwide, >90% of all children being vaccinated.
BCG is also administered to only those people at high risk.
A number of new vaccines are currently in development.

17. Epidemiology
 Roughly 1/3 of the world's population has been
infected with TB
 Tuberculosis is more common in developing
countries
 Asian and African countries-about 80%test
positive
 US population –Only 5–10% test positive
 India had the largest incidence-estimated 2 million
new cases
 The rates of TB varies with age.
 In Africa, it primarily affects adolescents and
young adults.
 TB is mainly a disease of older people and the
immunocompromised
Prevalence of TB was highest in sub-
Saharan Africa, and was also relatively
high in Asia.
Tuberculosis is the 2nd most common cause of death
from infectious disease

18. Leprosy
Introdution:
Latin word lepra, ="scaly",
Hansen’s disease(HD),
A chronic infection caused by Mycobacterium leprae and
Mycobacterium lepromatosis
World Leprosy Day was started in 1954
M. leprae, was discovered by G. H. Armauer Hansen
Effective treatment became available - 1940s
A 24-year-old man from Norway,
infected with leprosy, 1886

19. Caused By Mycobacterium leprae
Study of aetiology:
Differential Characteristics
 Nonmotile,
 Anaerobic,
 Acid-fast, Nonsporing,
 Rod Shaped,
 M.leprae is uncultivable in vitro,
 Intracellular parasite
Acid-fast Stain of A Mycobacterium leprae
Stock Culture

20. Classification of disease:
 WHO “Paucibacillary" and “Multibacillary"(based on proliferation of
bacteria),
 The SHAY scale provides 5 gradations,
 The ICD-10, uses Ridley-Jopling,
 In MeSH, 3 groupings are used.
Leprosy may also be divided into:
1) Early and indeterminate leprosy
2) Tuberculoid leprosy
3) Borderline tuberculoid leprosy
4) Borderline leprosy
5) Borderline lepromatous leprosy
6) Lepromatous leprosy
7) Histoid leprosy
8) Diffuse leprosy of Lucio and Latapí

21. Signs and symptoms:
 Symptoms of diphtheria include:
 Skin lesions (light or dark patches)-Primary external
 Leprosy progress can cause permanent damage to the
 skin,
 nerves,
 limbs, and
 eyes.
 Secondary infections
 Body parts can become numb or diseased
 tissue loss causing fingers and toes to become
shortened and deformed, as cartilage is absorbed into
the body
Hands deformed by leprosy

22. Diagnosis:
According to WHO, diagnosis in areas where people are frequently infected is
based on one of these main signs:
• Skin lesion consistent with leprosy and with definite sensory loss
• Positive skin smears
Skin lesions can be
• single or multiple,
• usually hypopigmented,
• reddish or copper-colored.
• macules (flat), papules (raised), or nodular.
Diagnosis is confirmed by acid-fast bacilli in a biopsy of the skin or
by detecting the DNA using polymerase chain reaction.

23. Mode of Transmission
Leprosy occurs by
close contact with infected.
by nasal droplets
aerosols
may also be transmitted by armadillos and
may be present in 3 species of non-human primates.
2 exit routes of M. leprae i) skin
ii)nasal mucosa,
Portal of Entry
 Upper Respiratory tract
 Skin

24. Treatment
A number of leprostatic agents are available for treatment.
Paucibacillary (PB or tuberculoid) cases-daily dapsone and monthly rifampicin for 6
months
Multibacillary (MB or lepromatous) cases,- daily dapsone and clofazimine along with
monthly rifampicin for 12 months is recommended.
Immunization Methods
BCG Vaccine is used arround the world
Diaminodiphenyl sulfone(DDS)
1950

25. Epidemiology
1st - India
2nd - Brazil
3rd – Myanmar
India reports over 50% of the worlds leprosy cases
WHO listed 91 countries in which leprosy is endemic
• India,
• Sri Lanka,
• Brazil,
• Madagascar,
• Mozambique,
• Tanzania, and
• Nepal … e.t.c
Leprosy inhabitants as per WHO

26. Tetanus
Introdution:
 Tetanus also known as lockjaw,
 An acute, often fatal, disease caused by exotoxin produced
by the bacteria
 An infection characterized by muscle spasms
 Etiology discovered in 1884 by Carle and Rattone
 Passive immunization used for treatment and prophylaxis
during World War I
 Tetanus toxoid first widely used during World War II

27. Caused By Clostridium tetani
Study of aetiology:
Differential Characteristics
 Motile,
 Endospore forming,
 Gram-positive
 Rod Shaped
 Anaerobic
 Survive autoclaving at 249.8°F (121°C) by 10–15 mnts
 Spores found in soil, animal feces
 Produces 2 exotoxins
i. tetanolysin and
ii. tetanospasmin
 Tetanospasmin estimated human lethal dose = 2.5 ng/kg
Gram Stain of A Clostridium tetani
Stock Culture

28. Types In Disease:
Generalized tetanus
Neonatal tetanus
Local tetanus
Cephalic tetanus
Tetanus Complications :
Laryngospasm
Fractures
Hypertension and/or
Abnormal heart rhythm
Nosocomial infections
Pulmonary embolism
Aspiration pneumonia
Death

29. Signs and symptoms:
 Spasms and stiffness in your jaw muscles
 Stiffness of your neck muscles
 Difficulty swallowing
 Stiffness of your abdominal muscles
 Painful body spasms lasting for several minutes, typically
triggered by minor occurrences, such as a draft, loud
noise, physical touch or light
Other signs and symptoms may include:
 Fever
 Sweating
 Elevated blood pressure
 Rapid heart rate

30. Diagnosis:
 There are no blood tests for diagnosing tetanus.
 Diagnosis is made on the basis of clinical presentation of symptoms
 Laboratory identification of C. tetani can be demonstrated only by production
of tetanospasmin in mice.
 Having recently experienced head trauma may indicate cephalic tetanus if no
other diagnosis has been made.
 The "spatula test" is a clinical test for tetanus that involves touching the
posterior pharyngeal wall with a soft-tipped instrument and observing the
effect.
 + test result is the involuntary contraction of the jaw (biting down on
"spatula")
 - test result would normally be a gag reflex attempting to expel foreign
object.

31. Mode of Transmission
Transmission is primarily by contaminated wounds (apparent and inapparent).
Tetanus may follow
• elective surgery,
• burns,
• deep puncture wounds,
• crush wounds,
• otitis media (ear infections),
• dental infection,
• animal bites,
• abortion, and
• pregnancy.
Portal of Entry
 Generally through a break in the skin (cut, puncture wound by a contaminated object)
Incubation Time
3 to 21 days
Tetanus is not contagious from
person to person. It is the only
vaccine-preventable disease that
is infectious but not contagious

32. Treatment
Mild tetanus
 tetanus immunoglobulin (TIG),also called tetanus antibodies or tetanus
antitoxin.(IV/IM)
 metronidazole (IV) for 10 days
 diazepam (oral or IV)
Severe tetanus
 In addition to the measures for mild tetanus
 Human tetanus immunoglobulin injected intrathecally
 Tracheotomy and mechanical ventilation for 3 to 4 weeks.
 Magnesium (IV) infusion,
 IV labetalol, magnesium, clonidine, or nifedipine
 Proper nutrition are required. 3,500 to 4,000 calories and
 150 g of protein per day(percutaneous endoscopic gastrostomy/parenteral nutrition).
 Full recovery takes 4 to 6 weeks as body must regenerate destroyed nerve axon
terminals

33. Immunization Methods
 DTaP (diphtheria and tetanus toxoids and
acellular pertussis vaccine) is the vaccine of
choice for children 6 weeks through 6 years of
age.
 The usual schedule is a primary series of four
doses at 2, 4, 6, and 15–18 months of age.
 The first, second, and third doses of DTaP should
be separated by a minimum of 4 weeks.
 The fourth dose should follow the third dose by
no less than 6 months and should not be
administered before 12 months of age.

34. Epidemiology
occurs worldwide , most frequently encountered in
densely populated regions in hot, damp climates with soil
rich in organic matter.
The neonatal form – remains a significant public health
problem in non-industrialized countries
Tetanus cases reported
worldwide (1990-2004)
About 10% of those infected with tetanus die

35. Food Poisoning
Introdution:
Food Poisoning =foodborne disease, foodborne illness
Illness resulting from the consumption of
• contaminated food
• pathogenic bacteria,
• viruses,
• parasites
• chemical or natural toxins(poisonous mushrooms)
Cause severe illness and even death.

36. Study Of Aetiology:
Poorly stored food in a refrigerator
Caused by
• improper handling, preparation, or food storage.
• Unhygiene practices before, during, and after food
preparation
• large variety of toxins that affect the environment
• pesticides or medicines in food and naturally toxic
substances
Agents Causing Food Poisoning
 Bacteria
 Viruses
 Parasites
 Natural toxins
 Other pathogenic agents.
 "Ptomaine poisoning"
Gram Stain of Clostridium botulinum
stock culture

37. Signs and symptoms:
The most common symptoms of food poisoning are:
• Nausea
• Vomiting
• Diarrhoea
• Stomach pains
Other symptoms include:
• Abdominal cramps
• Loss of appetite
• A high temperature (fever)
• Muscle pains
• Chills

38. Diagnosis:
 Diagnosis for food poisoning is made from the symptoms.
 A laboratory diagnosis for food poisoning is usually only needed if:
•Your symptoms are severe
•Your symptoms persist despite treatment
•You are showing signs of dehydration and/or
•There has been an outbreak of similar cases linked to a possible
source of contamination.
 Further testing is only needed if the symptoms indicate that infection has
spread from digestive system to other parts of the body.
 You may be asked to have investigations including blood tests (for
infection) and examination of stool sample.

39. Incubation Time
• Varies from type to type
• May range from hours to days
Treatment
• No specific treatment for food poisoning
• Depends on sympotoms
• Antibiotics are mostly used in case of bacteria
Protection and prevention
Prevent food poisoning by:
Cleaning
Cooking
Chilling
Cross-contamination
…e.t.c.

40. Epidemiology
Occurs Worldwide
Several Incidents are noticed
Noticed in countries like
• United States
• France
• Australia
• India
• France..e.t.c
The Food Standards Agency (FSA) estimates that there are
around 850,000 cases of food poisoning each year in the UK.

41. References
Text Book Of Microbiology by Anantha Narayan
Source
www.google.com
https://en.wikipedia.org/wiki/Tetanus
https://en.wikipedia.org/wiki/Tuberculosis
https://en.wikipedia.org/wiki/Foodpoisoning
https://en.wikipedia.org/wiki/Diptheria
https://en.wikipedia.org/wiki/Leprosy
www.vaccines.net
www.cdc.gov

42. Thank You