Disease chapter
A. Communicable disease
The diseases which are transferred from an infected person to a healthy person are called communicable diseases. These diseases are spread through water, food, sexual contact, sneezing or coughing. Communicable diseases are caused by bacteria, virus, parasitic protozoan, parasitic helminthes, fungus etc. Eg. Tuberculosis, HIV or AIDS, Giardiasis, Hepatitis etc.
SOCIALLY SIGNIFICANT
DISEASES
Any abnormal change that causes diseases and discomfort to the lives of both the concerned person and people around them is known as socially significant diseases. For example: drug abuse, smoking, alcoholism etc.
DRUG ABUSE
Drugs
They are the chemical substance that modifies the normal functioning of the body.
Abuse means wrong or bad use. So, drug abuse can be defined as use of drugs in nonmedical or illegal way that results in social, physical or emotional harm.
Drug Addiction
Prolonged use of drugs may lead to dependence of the body on them. This drug dependence or a condition of a feeling compelled to take certain drugs is known as drug addiction.
Types of Drugs: They are grouped into two main categories:
- Psychotropic drugs
- Psychedelic drugs
1. Psychotropic drugs
These drugs act on the brain and alter the behaviour. So, they are called mood-altering drugs. They are classified into following types:
a. Sedatives and tranquilizers
These drugs depress the activities of central nervous system (CNS) and give the feeling of calmness and relaxation in the body. For example: barbiturates (sleeping pills), benzodiazepine, etc.
b.
Opiate narcotics
These have depressing effects on the activities of CNS and relieve pain. For example: cocaine, heroin, brown sugar, etc.
c. Stimulants or antidepressant
These drugs stimulate the nervous system. For example: caffeine, amphetamines, etc.
2. Psychedelic drugs
They mainly act on CNS and greatly alter feelings, thoughts and perception. They cause optical or auditory illusion. For example: hallucinogens i.e. LSD (Lysergic Acid Diethylamide), bhang, Ganja, Charas (Hasish), Marijuana etc.
Causes of drug
addiction
1. Advertisement in media and description by addicts create curiosity for having personal experience.
2. Constant pressure of the friends or group circle (peer pressure).
3. Repeated use by parents or family members induces younger to taste them.
4. To overcome frustration and depression.
5. Some people take drugs to have fun and pleasure.
6. Some take drugs to increase their working capacity.
7. For the feeling of relaxation
8. In search of a more satisfying life.
Symptoms:
- Loss of appetite and body weight.
- Slurring of speech, impaired memory and concentration.
- Unsteady movement.
- Loss of interest in daily routine and sports.
- Unclear vision, red eyes and puffiness of eyes.
- Sleeplessness, lethargic and passive body.
- Depression and acute anxiety.
- Numerous injection marks in the body.
Effects:
a. Effects on the addict
- As it effects on brain, CNS may be permanently damaged.
- Can be the victim of various communicable diseases like AIDS, Hepatitis, and non-communicable diseases like psychosis.
- Loss of weight and appetite.
- Depression
- Abnormal and defective child birth.
- Unhappy daily life.
- Insecurity
- Decline an academic and working performance.
- Unusual smells, stains and marks.
b. Effects on family
- They become irresponsible towards their duty and job.
- Family suffers due to lack of basic needs.
- Losses of money leading to economic crisis.
- Disturb the environment of the family including divorce and suicide.
- Frustration and insecurity in the children.
- Children and other family members may copy and become drug addicted.
Control Measures:
- Early detection, treatment and rehabilitation of addicts.
- Psychological treatment which involves slow treatment, understanding their problems and helping them to come out of it.
- Anti drug campaign including youths to discourage the use of drugs.
- Providing school education involving students and parents.
- Parents should provide friendly atmosphere at home.
- Ban an illegal activities regarding production and selling of drugs.
- Enforcement of laws, rules and regulation to control the supply of drugs.
ALCOHOLISM
Alcohol generally refers to ethyl alcohol or ethanol (C2H5OH). They are produced by fermentation of fruits and grains.
C6H12O6
2C2H5OH +
2CO2
There are various alcoholic beverages like malted liquors (3-6%), wines (12-20%), Spirit (40-50%)
Alcohol addiction:
The regular consumption of alcohol that leads to the dependence of the body on it is called alcohol addiction.
Causes:
- Imitation and pressure of friend (peer pressure).
- For overcoming frustration and failures.
- Influence of advertisements
- Some people consume it for fashion and show-off.
-Some may drink as a part of religious or social traditions.
-Due to disturbed family life.
- In order to reduce tension and get relief from pain.
Effects:
1. Effects on Individual
A. On nervous system
It can cause the following anaesthetic effect on nervous system.
- Loss of self-control and judgement.
- Double vision and improper judgement of distance.
- Loss of emotional control.
- Loss of memory.
- Leads to neuritis.
B. On digestive system
- Causes gastritis.
- Swelling of liver due to fat deposition.
- Liver Cirrhosis (increase of fibrous tissue in the liver).
C. On heart and circulatory system
- It increases blood pressure due to fat deposition in blood vessels.
- It dilates blood vessels and leads to several heart diseases.
- It increases or reduces blood sugar level instead of keeping constant.
D. On kidney
- It affects the normal functioning of the nephrons in kidney.
E. On reproduction
In woman it effects on ovulation and menstruation cycle. In pregnant woman it can cause physical and mental disabilities in unborn babies.
2. On Family
- Economic crisis on family.
- Disturbance in family relationships.
- Irresponsible towards duty.
- Children suffer from frustration and depression.
- Insecurity
- Increase in domestic problems like homicide, divorce and family instability.
3. on Society
- Increase in road accidents and crimes like rapes, corruption, etc.
- Loss of social reputation and personality.
- Injuries from fights, falls, burns and even immediate death.
Symptoms of alcoholism
-Loss of self-control, power, judgement and emotional control.
-Visual problems like double vision, blessed vision.
-Gastritis, high B.B., neuritis, anaemia, etc.
-Shaking of hands even when alcohol is not taken.
-In women it affects ovulation and menstrual cycle.
Control
-Rehabilitation and psychological treatment.
-Drinking should be prohibited at public places.
-Sales should be allowed only from authorised shops.
-Heavy taxation on alcohol to restrict people to buy.
-Strict rules should be made for production and selling of alcohol.
-Providing school education, community and health education.
SMOKING
Consumption of tobacco in the form of cigarettes, bidis, pipes, Hukkah, etc. is known as smoking. Tobacco comes from the leaves of tobacco plants (Nicotiana tobaccum and N. rustica). The leaves of tobacco plant is dried and processed to make different products. The prolonged use of tobacco may lead to the dependence of the body on them is called tobacco addiction. Tobacco contains highly poisonous drug called nicotine.
Nepal is ranked on top in smoking. About 55% of total population consumes tobacco.65% in mountain, 46% in hills and 41% in Terai. About 48.4% of tobacco consumers are below 15 years.
Causes
-Imitation and pressure of friends (peer pressure).
-Due to frustration.
-Many people consume it for fashion and show off.
-Due to tradition or on religious occasions.
-Influence of advertisement seniors.
Symptoms
-Smoking makes the lips darker and mouth dry.
-Morning cough.
-Increases the rate of heart beat.
-Decreases the senses of smell and taste.
-Hoarseness of voice.
-In case of hemp products, the mouth becomes dry and the eyes become red.
Hemp plant
There are two species of hemp plant Cannabis indica and C. sativa. Their dry leaves and flowers yield various drugs. The drugs prepared by hemp plant are charas, bhang, marijuana (Hashish).
Effects of hemp products
-Fear and confusion.
-Senselessness
-Red eye and dry mouth
-Increase blood pressure and heart rate
-Sound and colour become more intense.
Effects of smoking
a) Cancer: Cigarette smoke contains chemical substances called carcinogen that causes the cancers of lungs, lips, gums and mouth.
b) Bronchitis:Smokers are highly susceptible to chronic bronchitis.
c) Heart disease: Smoking constricts blood vessels that increase heart rate. It also decreases oxygen carrying capacity of blood.
d) Asthma: Smoking constricts the path in bronchioles and lungs that leads to asthma.
e) Birth defect:In pregnant women,it causes physical and mental disabilities in unborn babies and increases the chance of miscarriage.
f) Smoking can also cause pulmonary tuberculosis, and gastric ulcers.
g) Socioeconomic effect:
-Economic loss.
-Disturbs non-smokers.
-Increases the chances of fire.
Control
-Ban on production and selling of tobacco
-Providing health education at school and community
-Implementation of heavy taxation on tobacco production
-Public places should be declared as no smoking zone
-Sales should be allowed only from authorized shops. Age bar must be determined
-Strict rules and regulation should be made to control it.
INFECTIOUS DISEASES
TYPHOID (ENTERIC FEVER)
It is highly communicable bacterial disease that causes acute infection of intestine.
Distribution: It is
cosmopolitan in distribution. It is mainly prevalent in Asia, Africa and Latin
America. It is common in rainy season and in areas having lack of sanitation
Causative Agent
It is caused by flagellated
bacillus bacterium called Salmonella
typhi.
Mode of infection
This spreads by direct or indirect contact with infected person or carrier. The primary source of infection is faeces or urine of infected person and the secondary source is contaminated water, food, etc.
Incubation period
It is the period between the infection of pathogenic organism and first appearance of the symptoms of the diseases. The incubation period of typhoid is 2 weeks on average.
Symptoms
- High fever for about2- 3weeks.
-Intestinal walls show lesions, haemorrhage and ulceration.
-Enlargement of spleen, abdominal tenderness, slow pulse rate and rose like rashes on skin.
-Constipation
-In 2- 3%cases death causes by haemorrhage.
Diagnosis: Widal test, stool or blood culture.
Prevention
-Personal cleanliness.
-Proper sanitation
-Proper disposal of human excreta
-Protection, Purification and chlorination of public water supply.
-Control of flies
-Public awareness through health education.
-Immunization (TAB) against typhoid
Treatment
Antibiotics like chloramphenicol, ampicillin, chloromycetin, amoxicillin, ciprofloxacin are used for the treatment. Treatment must be continued for several weeks to ensure the killing of bacteria.
TUBERCULOSIS (TB)
It is a highly communicable chronic bacterial disease that invades any part of the body, multiply rapidly and destroy tissues. However, it primarily affects lungs and causes pulmonary tuberculosis.
Distribution:
It is worldwide in distribution. It is more prevalent in rural areas as they live in dark and dirty congested places. In Nepal, nearly 50,000 new TB patients are added yearly among them 8,000-11,000 people die every year.
Types of TB:
On the basis of site of infection:
1. Pulmonary TB: The site of infection is lungs.
2. Extra pulmonary TB: The site of infection is other except lungs such as intestine, bones, skin, etc.
Causative agent:
It is caused by bacteria called Mycobacterium tuberculosis. M. tuberculosis is also known as tubercle bacilli as it causes lesions called tubercles. It releases a toxin called tuberculin which destroys the tissues and causes tuberculosis.
Mode of infection:
It is an airborne disease, which may get infected by direct or indirect by following ways:
-When droplets release during coughing, sneezing, talking etc is inhaled.
-Contact with open wounds of infected person.
-Ingestion of milk of infected cow.
-Use of items of patients like towel, clothes, bed etc.
-Self swallowing of infected sputum.
-It may be also transferred from infected mother from transplacental route.
Incubation period:
It is quite variable from few weeks to years, as bacteria can remain in the tissues and persistent for many years.
Symptoms:
-Persistent cough.
-Blood in sputum (Haemoptysis).
-Chest pain.
-Temperature rises in the evening.
-Loss of body weight.
-Loss of appetite.
-Sweating at night.
Diagnosis:
-Chest X-ray
-Blood test
-Sputum test, etc.
Prevention:
-Faecal matter and sputum of infected person should be buried.
-Contaminated object of infected person should sterilized properly.
-Milk of infected cow should not be used.
-Mass education about tuberculosis.
-Improvement of personal hygiene.
-BCG (Bacillus Calmette-Guerin) vaccination should be administered.
Treatment:
Rifampicin, Isoniazid, Streptomycin, Ethambutol etc. are anti tuberculosis drugs.
DOTS (Directly Observed
Treatment Short course), April, 2001.
It is also known as DOT (Directly Observed Therapy). It ensures the cure of TB by providing the medicine and confirming that it is taken under direct supervision.
The treatment of TB is tedious and lengthily because the patient should take the medicine regularly for 6-8 months. The poor uneducated patients neglect to take medicine regularly. So, relapse of disease occur as a result of which death may occur. Before, the implementation of DOTS country wide (April,2001), more than 50% TB patient dies even after treatment. So, IUATLD (International Union Against Tuberculosis and Lungs Disease) implemented DOTS to cure TB. DOTS ensures treatment with:
a) right drugs b) right doses c) at right interval
AIDS
(Acquired Immunodeficiency Syndrome), 1981
It is a highly communicable and serious viral disease that hampers the immune system of the human body
Distribution
It is worldwide in distribution. AIDS is thought to be originated from Central Africa. It is believed that its virus transmitted to man from African monkey.
Causative agent:
It is caused by retro-virus known as Human Immunodeficiency Virus (HIV). It was identified by French physician Dr. Luc Montagnier in the lymph node of homosexual. This virus impairs the T4 lymphocytes which produces T helper cells and memory cells. B cells cannot produce antibodies in the absence of helper cells. As body’s immune system breaks down, it allows other opportunistic infections to cause disease and patient are exposed to variety of disease.
Structure of HIV
Its structure is simple consisting two single strands of RNA and the enzyme reverse transcriptase with in double layer of lipids. It is spherical in shape. It consists of core having core protein chiefly P24 and P18, RNA and enzyme necessary for HIV replication; reverse transcriptase. The core is covered by a double layer of lipid membrane, different layers are embedded in the membrane forming spikes containing GP120 and GP41.
Mode of transmission
-Sexual transmission.
-Transfusion of infected blood.
-Maternal foetal transmission.
-Use of contaminated needle or syringe.
Phase of AIDS
It is divided into four phases:
a) Window period: This is the initial phase of disease which last 2-12 weeks. In this phase blood test doesn’t give any result.
b)
Healthy carrier: In this phase, blood test shows positive result (HIV+) but patient
is healthy without any symptoms. The patient can transmit virus to others.
c)
Prodromal phase: In this phase mild symptoms appear like headache, fever, cough,
weight loss, swelling of lymph nodes, etc.
d)
End phase: In this phase immunity power of patient is completely collapsed and
patient is attached by opportunistic diseases like typhoid, T.B, diarrhoea,
etc. Patient survives for short time only.
Incubation period:
It is uncertain ranging from few months to 10 years.
Symptoms:
Major
-Weight loss more than 10% of body weight.
-Prolonged fever and diarrhoea for more than a month.
-Night sweats.
-Swollen lymph glands.
Minor
- Persistent cough for more than a month.
- Dermatitis
- Fungal infection of mouth and throat (Candidiasis).
- Reddish brown nodules on skin.
- Fungal infection to central nervous system.
- Fever, headache, vomiting.
- Septicaemia (Blood poisoning).
Diagonosis:
It is made on the basis of pathological test of blood.
The technique of identifying the HIV antibodies in the blood is called ELISA test (Enzyme Linked Immunosorbent Assay).
Prevention:
- Public awareness and sex education.
-Avoid unsafe sex, condom should be used.
-Avoid multiple sex partners.
-Screening of blood before transfusion.
-Needle and syringe should not be shared.
-Early diagnosis and treatment of other sexually transmitted diseases.
-Infected women should avoid of being pregnant.
Treatment
No cure for HIV infection is known till now. However, drugs like Azidothymidine (AZT) or zidovudine, Didonosine (DDS) and zalcitabine are used which slows progressions of the disease and prolonged the life of patient.
Control measures:
-Sex education should be provided at school and community.
-Screening of blood before transfusion.
-Use of condoms as practice of safe sexual activities.
-Avoid sharing sharp and pointed objects.
VIRAL HEPATITIS
It is a communicable viral disease that affects liver causing temporary or permanent damage of it. There are six type of Hepatitis viz. Hepatitis A,B,C,D,E and G. Hepatitis A and B are well known type whereas C, D, E and G are less known.
Hepatitis A: It is also known as infectious hepatitis.
Distribution:
It is worldwide in distribution and common in rural areas during autumn and early winter. It mainly occurs in children and young adults.
Causative agent: Hepatitis A virus.
Incubation period: 15-40 days.
Mode of infection: It is transmitted by faeco-oral route i.e consumption of contaminated food and water.
Symptoms:
-Headache.
-Fever
-Nausea and vomiting.
-Epigastric discomfort.
-Jaundice
-Swelling of liver
-Yellow pigmentation in eyes and skin. -Indigestion.
-Blood test -Stool test -Liver function test
-There is no specific treatment of hepatitis A.
-Bed rest and soft and hygienic food without fat and protein like Sugarcane juice glucose water, fruits etc are recommended.
Prevention:
-Use of safe drinking water and food.
-Personal and community hygiene.
-Vaccination.
-Liver supporting medicine like liver tonic, fish liver oil should be taken.
Hepatitis B: It is also known as serum hepatitis. Its causative agent can survive outside the body for about 7 days. So, it is more dangerous than HIV.
Distribution: It is worldwide in distribution.
Causative agent: Hepatitis B virus (HBV)
Incubation period: 40-200 days.
Mode of infection:
-Blood transfusion and contact with body fluids like sweat, saliva, breast milk, tears, semen, etc.
-From infected mother to child.
-Sexual transmission.
Symptoms:
-Same as hepatitis A.
-Liver cancer.
-Cirrhosis of liver
-Chronic liver disease
Diagonosis:
-Liver biopsy -Liver function test.
Treatment: There is no specific treatment.
Prevention:
- Hepatitis B vaccination.
- Proper handling of blood and body fluid.
- Use of safe syringe, needle and sexual partner.
- Public awareness through health education.
Hepatitis C: It is also known as non-A, non-B (NA NB) hepatitis caused by Hepatitis C virus (HCV). It is mode of infection is parental and personal contact. Symptoms are similar to Hepatitis B.
Hepatitis D: It is also known as delta Hepatitis. It is caused by delta virus. It is a defective virus for which HBV is the helper. It uses B virus to reproduce itself and survive in the body. It’s mode of infection and symptoms is similar to Hepatitis B.
Hepatitis E: It is caused by Hepatitis E virus (HEV). It’s mode of transmission is similar to hepatitis A.
Hepatitis G:It is caused by flavivirus and is transmitted parenterally.
Hepatitis A Hepatitis B
|
1. It is caused by hepatitis A virus. |
1. It is caused by hepatitis B virus. |
|
2. HAV has single standard, linear RNA genome without a lipid capsule. |
2. HBV has a double standard, circular DNA genome with a lipid capsule. |
|
3. It is transmitted by faecal-oral route. |
3. It is transmitted by transfusion of contaminated blood and body fluid. |
|
4. Its incubation period is 15-40 days. |
4. Its incubation period is 40-200 days. |
|
5. It is benign and usually not fatal. |
5. It may be chronic and fatal. |
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