Tuberculosis

Tuberculosis, MTB, or TB (short for tubercle bacillus), in the past also called phthisis,
phthisis pulmonalis, or consumption, is a widespread, and in many cases fatal, infectious disease
caused by various strains of mycobacterium, usually Mycobacterium tuberculosis.
Tuberculosis typically attacks the lungs, but can also affect other parts of the body. It is spread
through the air when people who have an active TB infection cough, sneeze, or otherwise
transmit respiratory fluids through the air. Most infections do not have symptoms, known as
latent tuberculosis. About one in ten latent infections eventually progresses to active disease
which, if left untreated, kills more than 50% of those so infected.

The classic symptoms of active TB infection are a chronic cough with blood-tinged
sputum, fever, night sweats, and weight loss (the latter giving rise to the formerly common term
consumption). Infection of other organs causes a wide range of symptoms. Diagnosis of active
TB relies on radiology (commonly chest X-rays), as well as microscopic examination and
microbiological culture of body fluids. Diagnosis of latent TB relies on the tuberculin skin test
(TST) and/or blood tests. Treatment is difficult and requires administration of multiple
antibiotics over a long period of time. Social contacts are also screened and treated if necessary.
Antibiotic resistance is a growing problem in multiple drug-resistant tuberculosis (MDR-TB)
infections. Prevention relies on screening programs and vaccination with the bacillus Calmette-
Gurin vaccine.

Transmission
When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel
infectious aerosol droplets 0.5 to 5.0 m in diameter. A single sneeze can release up to 40,000
droplets. Each one of these droplets may transmit the disease, since the infectious dose of
tuberculosis is very small (the inhalation of fewer than 10 bacteria may cause an infection).

People with prolonged, frequent, or close contact with people with TB are at particularly
high risk of becoming infected, with an estimated 22% infection rate. A person with active but
untreated tuberculosis may infect 1015 (or more) other people per year. Transmission should
only occur from people with active TB - those with latent infection are not thought to be
contagious. The probability of transmission from one person to another depends upon several
factors, including 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. The cascade of person-to-person spread can be
circumvented by effectively segregating those with active ("overt") TB and putting them on anti-
TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant
active infections generally do not remain contagious to others. If someone does become infected,
it typically takes three to four weeks before the newly infected person becomes infectious
enough to transmit the disease to others.


There's 5 Stages of Tuberculosis :
1. Onset (1-7 Days) : The bacteria is inhaled

2. Symbiosis (7-21 Days) : If the bacteria does not get killed then it reproduces

3. Initial Caseous Necrosis (14-21 Days) : Tuberculosis starts to develop when the bacteria slows
down at reproducing, they kill the surrounding non-activated macrophages and run out of cells to
divide in. The bacteria then produces anoxic conditions and reduces the pH. The bacteria can't
reproduce anymore but can live for a long time.

4. Interplay of Tissue-Damaging and Macrophage Activating Immune Response (After 21 days)
: Macrohpages surround the tubercule but some may be inactive. Tuberculosis then uses it to
reproduce which causes it to grow. The turbecule can break off and spread around. If it spreads
in the blood you can develop tuberculosis outside the lungs, this is called Miliary Tuberculosis.

5. Liquification and Cavity Formation: The tubercules at one point will liquefy, which will make
the disease spread faster, not everyone will get to this stage. Only a small percent of people will
get to this stage.

Diphtheria
Corynebacterium diphtheriae causes the disease diphtheria which primarily affects the
upper respiratory tract. The bacteria can invade any of the mucous membranes and have a 2-5
day incubation period. Different sites of infection cause different clinical forms of diphtheria
with varying severity. The most commons site of infection is the pharynx and tonsils, but the
bacteria can also invade the nasal tissues, larynx and skin. Anterior nasal diphtheria is usually
quite similar to the common cold in symptoms and severity because the location of the infection
does not allow for large-scale systemic absorption of the diphtheria toxin.

Pharyngeal, tonsillar and laryngeal diphtheria are more severe because more toxin is
absorbed into the bloodstream. Early symptoms of this form of diphtheria include a sore throat
and fever, but after a few days a bluish-white adherent membrane, the pseudomembrane, forms
over the back of the throat and tonsils. The pseudomembrane is actually a fibrin network infected
with multiplying C. diphtheriae cells which grows over a necrotic lesion on the epithelial cells on
the back of the throat. The consequences of this membrane growth can be severe if the
membrane grows to the extent that it blocks the airway in the throat. This infection quickly
becomes acute as the bacterial toxin is absorbed into the bloodstream and lymphatic network.
Cutaneous diphtheria, or an infection of the skin, is much less common. Symptoms may include
a rash or ulcer on the skin. This form of the infection is generally less severe.

The ultimate outcome of the disease depends on how much toxin is absorbed into the
bloodstream. The toxin has degenerative effects on the heart, nerves, spleen, muscles, liver and
kidneys. In the most severe cases, an infected person will develop myocarditis or neuritis, which
leads to heart failure and local paralysis most commonly of the soft palate, respectively. The
fatality rate is approximately 5-10% of cases, but is higher for young children or the very old .

Diphtheria is an infectious disease spread by direct physical contact or breathing the
aerosolized secretions of infected individuals. Quinvaxem is a widely administered pentavalent
vaccine, which is a combination of five vaccines in one that protect infantile children from
Diphtheria, among other common child diseases. The disease may remain manageable, but in
more severe cases, lymph nodes in the neck may swell, and breathing and swallowing will be
more difficult. People in this stage should seek immediate medical attention, as obstruction in the
throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the
course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause
paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases will be put in
a hospital intensive care unit and be given a diphtheria antitoxin.

Period of Communicability
Variable, until virulent bacilli have disappeared from discharges and lesions. For
example: effective antibiotic therapy promptly ends shedding within 4 days; without treatment,
infectivity usually last 2 weeks or less (seldom more than 4 weeks); the rare chronic carrier may
shed organisms for 6 months or more.

Pertussis



Pneumonia

Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic
air sacs known as alveoli. It is usually caused by infection with viruses or bacteria and less
commonly other microorganisms, certain drugs and other conditions such as autoimmune
diseases.

Typical symptoms include a cough, chest pain, fever, and difficulty breathing. Diagnostic
tools include x-rays and culture of the sputum. Vaccines to prevent certain types of pneumonia
are available. Treatment depends on the underlying cause. Pneumonia presumed to be bacterial is
treated with antibiotics. If the pneumonia is severe, the affected person is, in general, admitted to
hospital.

Causes
Pneumonia is due to infections caused primarily by bacteria or viruses and less
commonly by fungi and parasites. Although there are more than 100 strains of infectious agents
identified, only a few are responsible for the majority of the cases. Mixed infections with both
viruses and bacteria may occur in up to 45% of infections in children and 15% of infections in
adults. A causative agent may not be isolated in approximately half of cases despite careful
testing.
Bacteria are the most common cause of community-acquired pneumonia (CAP), with
Streptococcus pneumoniae isolated in nearly 50% of cases.

Germs called bacteria or viruses usually cause pneumonia. Pneumonia usually starts
when you breathe the germs into your lungs. You may be more likely to get the disease after
having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is
easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease,
cancer, or diabetes also makes you more likely to get pneumonia.

Signs and symptoms

People with infectious pneumonia often have a productive cough, fever accompanied by
shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an
increased respiratory rate. In the elderly, confusion may be the most prominent sign. The typical
signs and symptoms in children under five are fever, cough, and fast or difficult breathing.

Fever is not very specific, as it occurs in many other common illnesses, and may be
absent in those with severe disease or malnutrition. In addition, a cough is frequently absent in
children less than 2 months old. More severe signs and symptoms may include blue-tinged skin,
decreased thirst, convulsions, persistent vomiting, extremes of temperature, or a decreased level
of consciousness.

Bacterial and viral cases of pneumonia usually present with similar symptoms. Some
causes are associated with classic, but non-specific, clinical characteristics. Pneumonia caused by
Legionella may occur with abdominal pain, diarrhea, or confusion, while pneumonia caused by
Streptococcus pneumoniae is associated with rusty colored sputum, and pneumonia caused by
Klebsiella may have bloody sputum often described as "currant jelly". Bloody sputum (known as
hemoptysis) may also occur with tuberculosis, Gram-negative pneumonia, and lung abscesses as
well as more commonly with acute bronchitis. Mycoplasma pneumonia may occur in association
with swelling of the lymph nodes in the neck, joint pain, or a middle ear infection. Viral
pneumonia presents more commonly with wheezing than does bacterial pneumonia.

Prevention

Prevention includes vaccination, environmental measures and appropriate treatment of
other health problems.

Vaccination prevents against certain bacterial and viral pneumonias both in children and
adults. Influenza vaccines are modestly effective against influenza A and B.