HED 2203 TROPICAL DISEASES

Tropical disease, any disease that is indigenous to tropical or subtropical areas of the world or
that occurs principally in those areas. Examples of tropical diseases include malaria,
cholera, yellow fever, and ulcer.
COMMUNICABLE DISEASE
Communicable diseases are diseases that can be spread from one person to another and cause a
large number of people to get sick. They are caused by germs like bacteria, viruses, fungi,
parasites or toxins.
Communicable diseases are illnesses caused by viruses or bacteria that people spread to one
another through contact with contaminated surfaces, bodily fluids, blood products, insect bites,
or through the air. There are many examples of communicable diseases, some of which require
reporting to appropriate health departments or government agencies in the locality of the
outbreak such as HIV, hepatitis A, B and C, measles, salmonella among others
Causes of Communicable Diseases
Microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or
indirectly, cause communicable or infectious diseases, from one person to another. Some are
transmitted through bites from insects while others are caused by ingesting contaminated food or
water.
Mode of Transmission of Communicable Diseases
The mode of transmission of the infectious agent of communicable diseases can be classified as
follows:
1. Waterborne diseases: transmitted by ingestion of contaminated water.
2. Food borne diseases: transmitted by the ingestion of contaminated food.
3. Airborne diseases: transmitted through the inhalation of polluted/contaminated air.
4. Vector-borne diseases: transmitted by vectors, such as mosquitoes and flies.
5. Contact borne disease: transmitted by direct contact with an infected person.

Control and Prevention of Communicable Diseases

 Handle & Prepare Food Safely
 Wash Hands Often
 Clean & Disinfect Commonly Used Surfaces

1
 Cough & Sneeze Into Your Sleeve
 Don't Share Personal Items.
 Get Vaccinated
 Avoid Touching Wild Animals
1. TYPHOID
Concept of Typhoid Fever
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many
organs. Without prompt treatment, it can cause serious complications and can be fatal. It’s
caused by a bacterium called salmonella typhi, which is related to the bacteria that cause
salmonella food poisoning.
Cause of Typhoid Fever
Typhoid fever is a life-threatening illness caused by the Salmonella enterica serotype Typhi
bacteria. It can also be caused by Salmonella paratyphi bacteria. Paratyphoid fever is a life-
threatening illness caused by Salmonella Paratyphi bacteria. The bacteria are deposited in water
or food by a human carrier and are then spread to other people in the area
Signs and Symptoms
The incubation period is usually 1-2 weeks, and the duration of the illness is about 3-4 weeks.
Symptoms include:
 Poor appetite
 Headaches
 Generalized aches and pains
 Fever as high as 104 degrees Fahrenheit
 Lethargy
 Diarrhea
 Chest congestion develops in many people abdominal pain and discomfort are common.
 The fever becomes constant
 About 10% of people have recurrent symptoms after feeling better for one to two weeks
 Relapses are actually more common in individuals treated with antibiotics
Mode of Transmission
Typhoid fever is contracted by the ingestion of contaminated food or water. These diseases are
spread through sewage contamination of food or water and through person-to-person contact.

2
People who are currently ill and people who have recovered but are still passing the bacteria in
their poop (stools) can spread Salmonella Typhi or Salmonella Paratyphi.
You can get typhoid fever or paratyphoid fever if you eat food or drink a beverage that has been
touched by a person who is shedding Salmonella Typhi or Salmonella Paratyphi in their stool
and who has not washed their hands thoroughly after going to the toilets.
Sewage contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water you drink.
Sewage contaminated with Salmonella Typhi or Salmonella Paratyphi gets into water used to
rinse food you eat raw.
Control and Prevention
 Refer the person with the signs and symptoms of typhoid fever to the clinic or hospital
for proper treatment:
 Get vaccinated against typhoid fever. Typhoid vaccines are only 50–80% effective, so
you should still be careful about what you eat and drink to decrease your risk of getting
typhoid fever.
 Practice safe eating and drinking habits. Carefully select what you eat and drink when
you travel. You can reduce your risk while traveling in countries where typhoid and
paratyphoid fever are common by boiling, cooking, or peeling food before eating
 Only drinking water that is bottled or has been boiled
 Avoiding drinks with ice, unless the ice is made from bottled or boiled water
 Washing your hands with soap and water before eating, drinking, or preparing food
 Not eating food prepared by anyone who is sick or was recently sick

3
 2. CHOLERA
Concept of Cholera
Cholera is an intestinal infection caused by Vibrio cholerae. The hallmark of the disease is
profuse secretory diarrhea. Cholera can be endemic, epidemic, or pandemic. Despite all the
major advances in research, the condition remains a challenge to the modern medical world.
Although the disease may be asymptomatic or mild, severe cholera can cause dehydration and
death within hours of onset.
Cause
Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water
contaminated by feces from a person with the infection.
Common sources include:
 Municipal water supplies
 Ice made from municipal water
 Foods and drinks sold by street vendors
 Vegetables grown with water containing human wastes
 Raw or undercooked fish and seafood caught in waters polluted with sewage
 When a person consumes the contaminated food or water, the bacteria release a toxin in the
intestines that produces severe diarrhea.
Signs and Symptoms of Cholera Disease
Symptoms of cholera can begin as soon as a few hours or as long as five days after infection.
Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected
have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration.
Although many infected people may have minimal or no symptoms, they can still contribute to
spread of the infection.
Signs and symptoms of dehydration are:
 Rapid heart rate
 Loss of skin elasticity (the ability to return to original position quickly if pinched)
 Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
 Low blood pressure
 Thirst
 Muscle cramps

4
 Signs and symptoms of cholera dehydration include irritability, fatigue, sunken eyes, a
dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a
fold, little or no urinating, low blood pressure, and an irregular heartbeat. If not treated,
dehydration can lead to shock and death in a matter of hours.
Mode of Cholera Transmission
The mode of Cholera Transmission is through the consumption of contaminated water or food by
faeces or vomitus from cholera patient.
Control and Prevention of Cholera
 Refer the person who shows the signs and symptoms of cholera to the clinic or hospital
immediately for proper treatment.
 There is a vaccine for cholera. Both the CDC and the World Health Organisation have
specific guidelines for who should be given this vaccine.
 You can protect yourself and your family by using only water that has been boiled, water
that has been chemically disinfected or bottled water. Be sure to use bottled, boiled, or
chemically disinfected water for the following purposes
 Drinking
 Preparing food or drinks
 Making ice
 Brushing your teeth
 Washing your face and hands
 Washing dishes and utensils that you use to eat or prepare food
 Washing fruits and vegetables
 You should also avoid raw foods, including:
 Unpeeled fruits and vegetables
 Unpasteurized milk and milk products
 Raw or undercooked meat or shellfish
 Fish caught in tropical reefs, which may be contaminated
3. DYSENTERY
Concept of Dysentery
Many people have spent a tropical vacation with a bad stomach bug. They might have had
dysentery, a painful intestinal infection that is usually caused by bacteria or parasites. Dysentery

5
is defined as diarrhea in which there is blood, pus, and mucous, usually accompanied by
abdominal pain. It usually lasts for 3 to 7 days. There are two main types of dysentery. The first
type, amoebic dysentery or intestinal amoebiasis, is caused by a single-celled, microscopic
parasite living in the large bowel. The second type, bacillary dysentery, is caused by invasive
bacteria. Both kinds of dysentery occur mostly in hot countries. Poor hygiene and sanitation
increase the risk of dysentery by spreading the parasite or bacteria that cause it through food or
water contaminated from infected human faeces. Dysentery is an intestinal inflammation,
primarily of the colon. It can lead to mild or severe stomach cramps and severe diarrhea with
mucus or blood in the faeces. Without adequate hydration, it can be fatal. Infection with the
Shigella bacillus, or bacterium, is the most common cause.
Causes of Dysentery
Dysentery can have a number of causes. Bacterial infections are by far the most common causes
of dysentery. These infections include Shigella, Campylobacter, Entamoeba coli, and Salmonella
species of bacteria. The frequency of each pathogen varies considerably in different regions of
the world. Dysentery is rarely caused by chemical irritants or by intestinal worms. The Shigella
and Campylobacter bacteria that cause bacillary dysentery are found all over the world. They
penetrate the lining of the intestine, causing swelling, ulcerations, and severe diarrhea containing
blood and pus. Intestinal amoebiasis is caused by a protozoan parasite, Entamoeba histolytica.
The amoeba can exist for long periods of time in the large bowel (colon). In the vast majority of
cases, amoebiasis causes no symptoms only 10% of infected individuals become ill.
Mode of Transmission of Dysentery
People can become infected after ingesting water or food contaminated with somebody’s
excreted parasites. People are at high risk of acquiring the parasite through food and water if the
water for household use is not separated from waste water. The parasites can also enter through
the mouth when hands are washed in contaminated water. If people neglect to wash properly
before preparing food, the food may become contaminated. Fruits and vegetables can be
contaminated if washed in polluted water or grown in soil fertilized by human waste. Having sex
that involves anal contact may spread amoebic and bacillary dysentery. This is especially true if
the sex included direct anal-oral contact, or oral contact with an object (e.g., fingers) that touched
or was in the anus of an infected person

6
Signs and Symptoms of Dysentery
Symptoms can show up 1-3 days after you get infected. In some people, the symptoms take
longer to appear. Others never get symptoms. Each type of dysentery has slightly different
symptoms. The main signs and symptom of dysentery is frequent near-liquid diarrhea flecked
with blood, mucus, or pus. Other symptoms include:
 sudden onset of high fever (at least 100.4°F or 38°C) and chills
 abdominal pain
 cramps and bloating
 flatulence (passing gas)
 urgency to pass stool
 feeling of incomplete emptying
 loss of appetite
 weight loss
 headache
 fatigue
 nausea
 vomiting
 dehydration
Other symptoms may be intermittent and may include recurring low fevers, abdominal cramps,
increased gas, and milder and firmer diarrhea. You may feel weak and tired, or lose weight over
a prolonged period (emaciation). Mild cases of bacillary dysentery may last 4 to 8 days, while
severe cases may last 3 to 6 weeks. Amoebiasis starts more gradually and usually lasts about 2
weeks. Bacillary dysentery symptoms begin within 2 to 10 days of infection. In children, the
illness starts with fever, nausea, vomiting, abdominal cramps, and diarrhea. Episodes of diarrhea
may increase to as much as once an hour with blood, mucus, and pus in the child's stool.
Vomiting and diarrhea may result in rapid and severe dehydration, which may lead to shock and
death if not treated.
Signs of dehydration include an extremely dry mouth, sunken eyes, and poor skin tone. Children
and infants will be thirsty, restless, irritable, and possibly lethargic. Children may not be able to
produce tears or urine, the latter appearing very dark and concentrated. Complications from
bacillary dysentery include delirium, convulsions, and coma. A very severe infection like this

7
can be fatal within 24 hours. However, the vast majority of infections are self-limited and resolve
spontaneously without treatment. People with amoebic dysentery may experience other problems
associated with amoebiasis. The most frequent complication results when parasites spread to the
liver, causing an amoebic abscess. In this case, you would have a high fever and experience
weight loss and right shoulder or upper abdominal pain. If the infection of the bowel is especially
virulent, the intestinal ulcerations may lead to bowel perforation and death. The parasites may
rarely spread through the bloodstream, causing infection in the lungs, brain, and other organs.
Control and Prevention of Dysentery
 Refer the person immediately to the health centre for proper treatment.
 Hand washing is the most important way to stop the spread of infection.
 You are infectious to other people while you are ill and have symptoms.
Take the following steps to avoid passing the illness on to others:
 Wash your hands thoroughly with soap and water after going to the toilet.
 Stay away from work or school until you have been completely free from any symptoms
for at least 48 hours.
 Help young children to wash their hands properly.
 Do not prepare food for others until you have been free of symptoms for at least 48 hours.
 Do not go swimming until you have been free of symptoms for at least 48 hours.
 Where possible, stay away from other people until your symptoms have stopped.
 Wash all dirty clothes, bedding and towels on the hottest cycle of your washing machine.
 Clean toilet seats and toilet bowls, flush handles, taps and sinks with detergent and hot
water after use, followed by a household disinfectant.
 Avoid sexual contact until you have been free of symptoms for at least 48 hours.

4. POLIOMYELITIS

Concept of Poliomyelitis

Poliomyelitis, commonly called polio, is a highly infectious disease, caused by the poliomyelitis
virus. The vast majority of poliovirus infections do not produce symptoms, but 5 to 10 out of 100
people infected with polio may have some flu-like symptoms. In 1 in 200 cases, the virus

8
destroys parts of the nervous system, causing permanent paralysis in the legs or arms. Although
very rare, the virus can attack the parts of the brain that help you breathe, which can cause death.
Despite efforts to eradicate it, there continues to exist children with permanent paralysis due to
this virus in some developing countries. Because of the risk of importation, the main risk factor
for children under 5 years of age to acquire this disease is low vaccination coverage

Causes of Poliomyelitis

A virus called poliovirus causes polio. The virus enters the body through the mouth or nose,
getting into the digestive and respiratory (breathing) systems. It multiplies in the throat and
intestines. From there, it can enter the bloodstream.

Mode of Poliomyelitis Transmission

The polio virus enters the body through the mouth, usually from hands contaminated with the
stool of an infected person. Polio is more common in infants and young children and occurs
under conditions of poor hygiene. The virus spreads from person to person and can infect a
person’s spinal cord, causing paralysis (can’t move parts of the body). Polio is spread when the
stool of an infected person is introduced into the mouth of another person through contaminated
water or food (fecal- oral transmission). Oral-oral transmission by way of an infected person's
saliva may account for some cases.

Signs and Symptoms

Symptoms such as fever, muscle weakness, headache, nausea and vomiting; One to two percent
of infected persons develop severe muscle pain and stiffness in the neck and back. Less than one
percent of polio cases result in paralysis. Most people who get infected with poliovirus about 72
out of 100 will not have any visible symptoms. may include:

 Sore throat
 Fever
 Tiredness
 Nausea

9
  Headache
 Stomach pain

A smaller proportion of people with poliovirus infection will develop other, more serious
symptoms that affect the brain and spinal cord:

 Paresthesia that is feeling of pins and needles in the legs

 Meningitis that is infection of the covering of the spinal cord and/or brain occurs in about
1 out of 25 people with poliovirus infection
 Paralysis that is can’t move parts of the body or weakness in the arms, legs, or both,
occurs in about 1 out of 200 people with poliovirus infection
 Paralysis is the most severe symptom associated with polio, because it can lead to
permanent disability and death. Between 2 and 10 out of 100 people who have paralysis
from poliovirus infection die, because the virus affects the muscles that help them
breathe.
Control and Prevention

Refer all those who show the signs and symptoms of poliomyelitis to the health centre for proper
treatment. The best way to prevent polio is by vaccination. The inactivated polio vaccine (IPV) is
given as a shot and the oral polio vaccine (OPV). Children should receive four doses of IPV
vaccine starting at birth. Vaccination schedule:
1. 1 dose at birth
2. a second dose 4 or more weeks after the first dose
3. a third dose 4 or more weeks after the second dose
4. a fourth dose 6 or more months after the third dose
5. and a booster dose at 5 years

5. COVID-19
Concept of COVID-19
Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus now
called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-
nCoV), which was first identified amid an outbreak of respiratory illness cases in Wuhan City,

10
Hubei Province, China. It was initially reported to the WHO on December 31, 2019. On January
30, 2020, the WHO declared the COVID-19 outbreak a global health emergency. On March 11,
2020, the WHO declared COVID-19 a global pandemic, its first such designation since declaring
H1N1 influenza a pandemic in 2009.
Cause of Covid 19
Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus called
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV),
which was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei
Province, China or it is cause by Coronaviruses
Signs and Symptoms of Covid 19
Coronaviruses are relatively simple structures, and their form helps us to understand how they
work. They are spherical and coated with spikes of protein. These spikes help the virus bind to
and infect healthy cells. Most common signs and symptoms are:
 Fever
 dry cough
 tiredness and Less common symptoms:
 aches and pains
 sore throat
 diarrhea
 conjunctivitis
 headache
 loss of taste or smell
 a rash on skin, or discolouration of fingers or toes
Mode of transmission
The disease is transmitted through air and direct contact with an infected person
Control and Prevention of COVID19
 Wearing of mask of nose and mouth
 Refer the person with the signs and symptoms of Covid 19 to the hospital for expert
management.
 Hand washing with soap is one of the cheapest, most effective things you can do to
protect yourself and others against corona virus disease.

11
To prevent the spread of COVID-19:
 Clean your hands often. Use soap and water, or an alcohol-based hand rub.
 Maintain a safe distance from anyone who is coughing or sneezing.
 Wear a mask when physical distancing is not possible.
 Don’t touch your eyes, nose or mouth with hands
 Cover your nose and mouth with your bent elbow or a tissue when you cough or sneeze.
 Stay home if you feel unwell.
 If you have a fever, cough and difficulty breathing, seek medical
6. TUBERCULOSIS
Concept of Tuberculosis
Tuberculosis (TB) is a contagious infection that usually attacks your lungs. It can also spread to
other parts of your body, like your brain and spine. A type of bacteria called Mycobacterium
tuberculosis causes it
Tuberculosis Types
There are three forms of Tuberculosis disease:
Latent TB. You have the germs in your body, but your immune system keeps them from
spreading. You do not have any symptoms, and you are not contagious. But the infection is still
alive and can one day become active. If you are at high risk for re-activation for instance, if you
have HIV, you had an infection in the past 2 years, your chest X-ray is unusual, or your immune
system is weakened your doctor will give you medications to prevent active TB.
Active TB. Active TB is an illness in which the TB bacteria are rapidly multiplying and invading
different organs of the body. The typical symptoms of active TB variably include cough, phlegm,
chest pain, weakness, weight loss, fever, chills and sweating at night. A person with active
pulmonary TB disease may spread TB to others by airborne transmission of infectious particles
coughed into the air.
Miliary TB. Miliary TB is a rare form of active disease that occurs when TB bacteria find their
way into the bloodstream. In this form, the bacteria quickly spread all over the body in tiny
nodules and affect multiple organs at once. This form of TB can be rapidly fatal
Causes of Tuberculosis
M. tuberculosis bacteria cause TB. They can spread through the air in droplets when a person
with pulmonary TB coughs, sneezes, spits, laughs, or talks.

12
Tuberculosis Risk Factors
You are more likely to get TB if:
 A friend, co-worker, or family member has active TB.
 You live in or have traveled to an area where TB is common
 You are part of a group in which TB is more likely to spread you work or live with
someone who is. This includes homeless people, people who have HIV, People in jail or
prison, and people who inject drugs into their veins.
 You work or live in a hospital or nursing home.
 You are a health care worker for patients at high risk of TB.
 You’re a smoker.
 A healthy immune system fights the TB bacteria. But you might not be able to fend off
active TB disease if you have: HIV or AIDS, Diabetes, Severe kidney disease, Head and
neck cancers, Cancer treatments such as chemotherapy, Low body weight and poor
nutrition, Medications for organ transplants
Tuberculosis Signs and Symptoms
Latent TB doesn’t have symptoms. A skin or blood test can tell if you have it.
Signs of active TB disease include:
 A cough that lasts more than 3 weeks, Chest pain, Coughing up blood, Feeling tired all
the time Night sweats, Chills, Fever, Loss of appetite and Weight loss
If you have any of these symptoms, see your doctor to get tested. Get medical help right away if
you have chest pain.
Mode of Tuberculosis Transmission
When someone who has TB coughs, sneezes, talks, laugh, or sing, they release tiny droplets that
contain the germs. If you breathe in these germs, you can get it. TB is not easy to catch. You
usually have to spend a long time around someone who has a lot of the bacteria in their lungs.
You are most likely to catch it from co-workers, friends, and family members.
Tuberculosis Tests and Diagnosis
There are two common tests for tuberculosis:
Skin test. This is also known as the Mantoux tuberculin skin test. A technician injects a small
amount of fluid into the skin of your lower arm. After 2 or 3 days, they will check for swelling in
your arm. If your results are positive, you probably have TB bacteria. But you could also get a

13
false positive. If you have gotten a tuberculosis vaccine called bacillus Calmette-Guerin (BCG),
the test could say that you have TB when you really do not. The results can also be false
negative, saying that you do not have TB when you really do, if you have a very new infection.
You might
Get this test more than once.
Blood test. These tests, also called interferon-gamma release assays (IGRAs), measure the
response when TB proteins are mixed with a small amount of your blood. Those tests don’t tell
you if your infection is latent or active. If you get a positive skin or blood test, your doctor will
learn which type you have with:
A chest X-ray or CT scan to look for changes in your lungs
Acid-fast bacillus (AFB) tests for TB bacteria in your sputum, the mucus that comes up when
you cough
Tuberculosis Treatment
Your treatment will depend on your infection.
 If you have latent TB, your doctor will give you medication to kill the bacteria so the
infection does not become active. You might get isoniazid, rifapentine, or rifampin, either
alone or combined. You will have to take the drugs for up to 9 months. If you see any
signs of active TB, call your doctor right away.
 A combination of medicines also treats active TB. The most common are ethambutol,
isoniazid, pyrazinamide, and rifampin. You will take them for 6 to 12 months.
 If you have drug-resistant TB, your doctor might give you one or more different
medicines. You may have to take them for much longer, up to 30 months, and they can
cause more side effects.
 Whatever kind of infection you have, it is important to finish taking all of your
medications, even when you feel better. If you quit too soon, the bacteria can become
resistant to the drugs.
Tuberculosis Prevention
To help stop the spread of TB:
 If you have a latent infection, take all of your medication so it doesn’t become active and
contagious.
 If you have active TB, limit your contact with other people.

14
  Cover your mouth when you laugh, sneeze, or cough. Wear a surgical mask when you’re
around other people during the first weeks of treatment.
 If you’re traveling to a place where TB is common, avoid spending a lot of time in
crowded places with sick people.
 Children in countries where TB is common often get the BCG vaccine. Other vaccines
are being developed and tested.
7. YELLOW FEVER
Concept of Yellow Fever
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The
"yellow" in the name refers to the jaundice that affects some patients.
Cause of Yellow Fever
It is caused by virus which is endemic in tropical areas of Africa and Central and South America.
Signs and Symptoms
Signs and symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea,
vomiting and fatigue
Route of Yellow Fever Transmission
The yellow fever virus is an arbovirus of the flavivirus genus and is transmitted by mosquitoes,
belonging to the Aedes and Haemogogus species. The different mosquito species live in different
habitats, some breed around houses (domestic), others in the jungle (wild), and some in both
habitats (semi-domestic). There are 3 types of transmission cycles:
Sylvatic (or jungle) yellow fever: In tropical rainforests, monkeys, which are the primary
reservoir of yellow fever, are bitten by wild mosquitoes of the Aedes and Haemogogus species,
which pass the virus on to other monkeys. Occasionally humans working or travelling in the
forest are bitten by infected mosquitoes and develop yellow fever.
Intermediate yellow fever: In this type of transmission, semidomestic mosquitoes (those that
breed both in the wild and around households) infect both monkeys and people. Increased
contact between people and infected mosquitoes leads to increased transmission and many
separate villages in an area can develop outbreaks at the same time. This is the most common
type of outbreak in Africa.
Urban yellow fever: Large epidemics occur when infected people introduce the virus into
heavily populated areas with high density of Aedes aegypti mosquitoes and where most people

15
have little or no immunity, due to lack of vaccination or prior exposure to yellow fever. In these
conditions, infected mosquitoes transmit the virus from person to person.
Control and Prevention
Good and early supportive treatment in hospitals improves survival rates. There is currently no
specific anti-viral drug for yellow fever but specific care to treat dehydration, liver and kidney
failure, and fever improves outcomes. Associated bacterial infections can be treated with
antibiotics. The most effective way to prevent infection from Yellow Fever virus is to prevent
mosquito bites. Mosquitoes bite during the day and night. Use insect repellent, wear long-sleeved
shirts and pants, treat clothing and gear, and get vaccinated before traveling, if vaccination is
recommended for you.
1. Vaccination
Vaccination is the most important means of preventing yellow fever. The yellow fever vaccine is
safe, affordable and a single dose provides life-long protection against yellow fever disease.
Several vaccination strategies are used to prevent yellow fever disease and transmission: routine
infant immunization; mass vaccination campaigns designed to increase coverage in countries
at risk; and vaccination of travellers going to yellow fever endemic areas. In high-risk areas
where vaccination coverage is low, prompt recognition and control of outbreaks using mass
immunization is critical. It is important to vaccinate most (80% or more) of the population at risk
to prevent transmission in a region with a yellow fever outbreak. There have been rare reports
of serious side-effects from the yellow fever vaccine. The risk of AEFI is higher for people over
60 years of age and anyone with severe immunodeficiency due to symptomatic HIV/AIDS or
other causes, or who have a thymus disorder. People over 60 years of age should be given the
vaccine after a careful riskbenefit assessment. People who are usually excluded from vaccination
include:
 infants aged less than 9 months;
 pregnant women except during a yellow fever outbreak when the risk of infection is high;
 people with severe allergies to egg protein; and
 people with severe immunodeficiency due to symptomatic HIV/AIDS or other causes, or
who have a thymus disorder.

16
In accordance with the International Health Regulations (IHR), countries have the right to
require travelers to provide a certificate of yellow fever vaccination. If there are medical
grounds for not getting vaccinated, this must be certified by the appropriate authorities. The IHR
are a legally binding framework to stop the spread of infectious diseases and other health threats.
Requiring the certificate of vaccination from travelers is at the discretion of each State Party, and
it is not currently required by all countries.
2. Vector control
The risk of yellow fever transmission in urban areas can be reduced by eliminating potential
mosquito breeding sites, including by applying larvicides to water storage containers and other
places where standing water collects. Both vector surveillance and control are components of the
prevention and control of vector-borne diseases, especially for transmission control in epidemic
situations. For yellow fever, vector surveillance targeting Aedes aegypti and other Aedes species
will help inform where there is a risk of an urban outbreak. Understanding the distribution of
these mosquitoes within a country can allow a country to prioritize areas to strengthen their
human disease surveillance and testing, and to consider vector control activities. There is
currently a limited public health arsenal of safe, efficient and cost-effective insecticides that can
be used against adult vectors. This is mainly due to the resistance of major vectors to common
insecticides and the withdrawal or abandonment of certain pesticides for reasons of safety or the
high cost of re-registration.
Personal preventive measures such as clothing minimizing skin exposure and repellents are
recommended to avoid mosquito bites. The use of insecticide-treated bed nets is limited by the
fact that Aedes mosquitos bite during the daytime.
Epidemic preparedness and response
Prompt detection of yellow fever and rapid response through emergency vaccination campaigns
are essential for controlling outbreaks. However, underreporting is a concern the true number of
cases is estimated to be 10 to 250 times what is now being reported. WHO recommends that
every at-risk country have at least one national laboratory where basic yellow fever blood tests
can be performed. A confirmed case of yellow fever in an unvaccinated population is considered
an outbreak. A confirmed case in any context must be fully investigated. Investigation teams
must assess and respond to the outbreak with both emergency measures and longer-term
immunisation plans.

17
8. MALARIA FEVER
Concept of Malaria Fever
Malaria is an infectious disease caused by protozoan parasites from the Plasmodium family that
can be transmitted by the bite of the Anopheles mosquito or by a contaminated needle or
transfusion. Falciparum malaria is the most deadly type. Malaria is caused by Plasmodium
parasites. The parasites are spread to people through the bites of infected female Anopheles
mosquitoes, called "malaria vectors."
There are 5 parasite species that cause malaria in humans, and 2 of these species P. falciparum
and P. vivax pose the greatest threat. In 2018, P. falciparum accounted for 99.7% of estimated
malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region,
71% of cases in the Eastern Mediterranean and 65% in the Western Pacific. P. vivax is the
predominant parasite in the WHO Region of the Americas, representing 75% of malaria cases.
Causes of Malaria
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the
bites of infected female Anopheles mosquitoes. Malaria can occur if a mosquito infected with the
Plasmodium parasite bites you. There are four kinds of malaria parasites that can infect humans:
Plasmodium vivax, P. ovale, P. malariae, and P. falciparum. P. falciparum causes a more severe
form of the disease and those who contract this form of malaria have a higher risk of death. An
infected mother can also pass the disease to her baby at birth. This is known as congenital
malaria.
Transmission of Malaria
In most cases, malaria is transmitted through the bites of female Anopheles mosquitoes. There
are more than 400 different species of Anopheles mosquito; around 30 are malaria vectors of
major importance. All of the important vector species bite between dusk and dawn. The intensity
of transmission depends on factors related to the parasite, the vector, the human host, and the
environment. Malaria is transmitted by blood, so it can also be transmitted through:
 an organ transplant
 a transfusion

18
Use of shared Transmission is more intense in places where the mosquito lifespan is longer (so
that the parasite has time to complete its development inside the mosquito) and where it prefers
to bite humans rather than other animals. The long lifespan and strong human-biting habit of the
African vector species is the main reason why approximately 90% of the world's malaria cases
are in Africa.
Transmission also depends on climatic conditions that may affect the number and survival of
mosquitoes, such as rainfall patterns, temperature and humidity. In many places, transmission is
seasonal, with the peak during and just after the rainy season. Malaria epidemics can occur when
climate and other conditions suddenly favour transmission in areas where people have little or no
immunity to malaria. They can also occur when people with low immunity move into areas with
intense malaria transmission, for instance to find work, or as refugees.
Signs and Symptoms of Malaria
The signs and symptoms of malaria typically develop within 10 days to 4 weeks following the
infection. In some cases, symptoms may not develop for several months. Some malarial parasites
can enter the body but will be dormant for long periods of time. Common signs and symptoms of
malaria include:
 shaking chills that can range from moderate to severe
 high fever
 profuse sweating
 headache
 nausea
 vomiting
 abdominal pain
 diarrhea
 anemia
 muscle pain
 convulsions
 coma
 bloody stools
Malaria Diagnoses

19
Your doctor will be able to diagnose malaria. During your appointment, your doctor will review
your health history, including any recent travel to tropical climates. A physical exam will also be
performed. Your doctor will be able to determine if you have an enlarged spleen or liver.
If you have symptoms of malaria, your doctor may order additional blood tests to confirm your
diagnosis. These tests will show:
 whether you have malaria
 what type of malaria you have
 if your infection is caused by a parasite that is resistant to certain types of drugs
 if the disease has caused anemia
 if the disease has affected your vital organ
Control and Prevention of Malaria
 Refer the person to the hospital for proper treatment
 There is no vaccine available to prevent malaria.
 Apply mosquito repellent with DEET (diethyltoluamide) to exposed skin.
 Drape mosquito netting over beds.
 Put screens on windows and doors.
 Treat clothing, mosquito nets, tents, sleeping bags and other fabrics with an insect
repellent called permethrin.
 Wear long pants and long sleeves to cover your skin.
 Sleeping under an insecticide-treated net (ITN) can reduce contact between mosquitoes
and humans by providing both a physical barrier and an insecticidal effect
 Proper environmental sanitation of the residence
 Effective surveillance is required at all points on the path to malaria elimination received
 Malaria elimination or the interruption of local transmission of a specified malaria
parasite species in a defined geographical area as a result of deliberate activities

NON-COMMUNICABLE DISEASES

WHO defines NCD or non-communicable disease as a chronic disorder that happens due to a
combination of a variety of factors like environmental, physiological, genetic as well as
behavioral factors. It is a non-infectious health condition, which cannot spread among people.

20
Still, they are responsible for around 70% of global deaths. Especially in middle and low-income
countries, they are the major cause of death.

Though NCDs are mostly associated with old age, they can affect all age groups. Various factors
like metabolic, behavioral, genetic and even socio-economic conditions play a vital role in
causing non-communicable diseases. Here, let us look at some examples of various non-
communicable diseases.

A person’s surroundings and lifestyle play a major role in determining NCDs. Some of the risk
factors and diseases associated with it are listed below. Most of these factors can also act
together as a cause for a single non-communicable disease.

 Diseases due to environmental factors – Skin cancer and malnutrition. These types of
NCDs can be caused due to air pollution, UV exposure or weather changes.

 Diseases due to physiological or metabolic factors – Cardiovascular diseases, obesity,

raised blood pressure, hyperlipidemia, hyperglycemia. These are mostly due to physical
inactivity, age and an unhealthy diet.

 Inherited diseases – Down’s syndrome, thalassemia, haemophilia and cystic fibrosis.

These diseases are mainly due to mutations and genetic inheritance. Most of these are
interrelated with behavioral factors like alcohol consumption, unbalanced diet,
tobacco usage and sedentary lifestyle.

 Autoimmune Diseases

Autoimmune diseases are also NCDs. This happens when the immune system is unable to
recognise its own body tissue which further leads to an abnormal immune response. This
type of disease cannot be spread from one person to another. Also, various environmental
and genetic risk factors are involved in causing these NCDs. Examples – rheumatoid
arthritis, celiac disease, multiple sclerosis, etc.

 Mental Health Disorders

Another major group of NCDs (non-communicable diseases) is mental health disorders.

Anxiety, OCD (obsessive-compulsive disorder), depression, schizophrenia, and bipolar

21
 disorder are some of the less noted non-communicable diseases. These types of mental
conditions can also cause premature mortality.

 Cardiovascular Disease Stroke, heart attack, peripheral artery diseases (PAD), coronary
artery disease, deep vein thrombosis, congenital heart disease, etc.
 Respiratory Disease Asthma, pulmonary hypertension, chronic obstructive pulmonary
disease (COPD), occupational lung disease, etc.
 Diabetes Type 1 diabetes, type 2 diabetes, gestational diabetes.
 Cancer Skin cancer, leukaemia, prostate cancer, lung cancer, break cancer, gastric
carcinoma, cervical cancer, bladder cancer, etc.
 Others Rheumatoid arthritis, neurodegenerative disease, osteoporosis, obesity,
depression, hypertension, cataracts, cognitive impairment, chronic kidney diseases, etc.

How to prevent NCDs?

Lowering the risk factors is the only way to prevent NCDs. Follow a healthy lifestyle with
adequate sleep, exercise and a balanced diet. Try relaxing your mind through meditation. This
will reduce depression, anxiety and hypertension. Also, it is a must to avoid alcohol and tobacco.
Smoking and chewing tobacco will directly contribute to chronic lung diseases and cancer.
Visiting genetic counsellors is the foremost way to prevent inheritable or genetic NCDs.
1. PEPTIC ULCER
PEPTIC ULCER DISEASE
Peptic ulcer disease occurs when open sores, or ulcers, form in the stomach or first part of the
small intestine. Many cases of peptic ulcer disease develop because a bacterial infection eats
away the protective lining of the digestive system. People who frequently take pain relievers are
more likely to develop ulcers.
What is peptic ulcer disease?
Peptic ulcer disease is a condition in which painful sores or ulcers develop in the lining of
the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of
mucus protects the stomach lining from the effect of its digestive juices. But many things can
reduce this protective layer, allowing stomach acid to damage the tissue.
Who is more likely to get ulcers?
One in 10 people develops an ulcer. Risk factors that make ulcers more likely include:

22
 Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common pain
relievers that includes ibuprofen
 family history of ulcers.
 Illness such as liver, kidney or lung disease.
 Regularly drinking alcohol.
 Smoking.
What causes ulcers?
People used to think that stress or certain foods could cause ulcers. But researchers haven’t found
any evidence to support those theories. Instead, studies have revealed two main causes of ulcers:
 Helicobacter pylori (H. pylori) bacteria.
 Pain-relieving NSAID medications.
H. pylori bacteria
H. pylori commonly infects the stomach. About 50% of the world’s population has an H.
pylori infection, often without any symptoms. Researchers believe people can transmit H.
pylori from person to person, especially during childhood.
The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation
(irritation), which can cause this protective lining to break down. This breakdown is a problem
because your stomach contains strong acid intended to digest food. Without the mucus layer to
protect it, the acid can eat into stomach tissue.
However, for most people the presence of H. pylori doesn’t have a negative impact. Only 10% to
15% of people with H. pylori end up developing ulcers .
Pain relievers
Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used
to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These
medications have the potential to cause peptic ulcers to form:
 Aspirin (even those with a special coating).
 Naproxen (Aleve®, Anaprox®, Naprosyn® and others).
 Ibuprofen (Motrin®, Advil®, Midol® and others).
 Prescription NSAIDs (Celebrex®, Cambia® and others).
Acetaminophen (Tylenol®) is not an NSAID and won’t cause damage to your stomach. People
who can’t take NSAIDs are often directed to take acetaminophen.

23
 Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H.
pylori infection is potentially the most dangerous. People who have H. pylori and who frequently
use NSAIDs are more likely to have damage to the mucus layer, and their damage can be more
severe. Developing an ulcer from NSAID use also increases if you:
 Take high doses of NSAIDs.
 Are 70 years or older.
 Are female.
 Use corticosteroids (drugs your doctor might prescribe for asthma, arthritis or lupus) at the same
time as taking NSAIDs.
 Use NSAIDS continuously for a long time.
 Have a history of ulcer disease.

Rare causes
Infrequently, other situations cause peptic ulcer disease. People may develop ulcers after:
 Being seriously ill from various infections or diseases.
 Having surgery.
 Taking other medications, such as steroids.

Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison
syndrome (gastrinoma). This condition forms a tumor of acid-producing cells in the digestive
tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of
acid that damages stomach tissue.
Can coffee and spicy foods cause ulcers?
It is a common misconception that coffee and spicy foods can cause ulcers. In the past, you
might have heard that people with ulcers should eat a bland diet. Now we know that if you have
an ulcer, you can still enjoy whatever foods you choose as long as they do not make your
symptoms worse.
What are some ulcer symptoms?
Some people with ulcers do not experience any symptoms. However, signs of an ulcer can
include:
 Gnawing or burning pain in your middle or upper stomach between meals or at night.

24
  Pain that temporarily disappears if you eat something or take an antacid.
 Bloating.
 Heartburn.
 Nausea or vomiting.
In severe cases, symptoms can include:
 Dark or black stool (due to bleeding).
 Vomiting.
 Weight loss.
 Severe pain in your mid- to upper abdomen.
DIAGNOSIS AND TESTS
How are ulcers diagnosed
Your healthcare provider may be able to make the diagnosis just by talking with you about your
symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H.
pylori infection. To confirm the diagnosis, you’ll need one of these tests:
Endoscopy
If you have severe symptoms, your provider may recommend an upper endoscopy to determine
if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube with
a tiny camera) through your throat and into your stomach to look for abnormalities.
H. Pylori tests
Tests for H. pylori are now widely used and your provider will tailor treatment to reduce your
symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your
provider can also look for it with a blood or stool test, or by taking a sample during an upper
endoscopy.
Imaging tests
Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have
to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the
imaging machines.
MANAGEMENT AND TREATMENT

25
 Will ulcers heal on their own?
Though ulcers can sometimes heal on their own, you should not ignore the warning signs.
Without the right treatment, ulcers can lead to serious health problems, including:
 Bleeding.
 Perforation (a hole through the wall of the stomach).
 Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the
stomach to the small intestine.
2. HEMORRHOIDS
Hemorrhoids, also known as piles, are swollen veins in the lower part of the anus and rectum.
When the walls of these vessels stretch, they can become irritated.
Although hemorrhoids can sometimes be painful, they often get better on their own. Lifestyle
changes, such as eating more fiber and exercising, can help relieve symptoms and lower the risk
of future hemorrhoids.
Causes
Although doctors do not fully understand why hemorrhoids appear, they may occur for the
following reasons:
 Pregnancy: During pregnancy, tissues in the rectum become weaker, and hormones
cause veins to relax and swell. Hemorrhoids may occur in up to 35%Trusted
Source of pregnant women.
 Aging: Hemorrhoids are most common among adults over age 50 yearsTrusted
Source. However, young people and children can also get them.
 Diarrhea: Hemorrhoids can occur after cases of chronic diarrhea.
 Chronic constipation: Straining to move stool puts additional pressure on the walls
of the blood vessels, which may result in hemorrhoids.
 Sitting for too long: Spending a long time in a seated position, especially on the
toilet, can cause hemorrhoids.
 Diet: Eating low fiber foods may contribute to hemorrhoids.
 Heavy lifting: Repeatedly lifting heavy objects can lead to hemorrhoids.
 Anal intercourse: This can cause new hemorrhoids or worsen existing ones.
 Weight: ResearchTrusted Source has linked being overweight to a higher chance of
hemorrhoids. This may result from increased pressure within the abdomen.

26
  Genetics: Some people inherit a tendency to develop hemorrhoids.
Types
Hemorrhoids can be either internal or external. Healthcare professionals use a grading system to
describe internal hemorrhoids based on whether they remain in the rectum or protrude out of the
anus.
Internal hemorrhoids are located inside the rectum and are not visible from the outside. They
are typically painless. Often, rectal bleeding is the first sign of internal hemorrhoids.
If an internal hemorrhoid protrudes through the anus, it’s called a prolapsed hemorrhoid. This
condition may be due to a weakening of the muscles around the anus and can be painful.
Healthcare professionals grade internal hemorrhoids from 1 to 4, depending on the degree of
prolapse:
 Grade 1 hemorrhoids remain in the rectum without prolapsing (protruding out of the anus).
 Grade 2 hemorrhoids prolapse when a person passes stool, then return inside on their own.
 Grade 3 hemorrhoids are prolapsed and must be pushed back in.
 Grade 4 hemorrhoids are prolapsed and cannot be pushed back in.
External hemorrhoids
External hemorrhoids occur in the skin around the anus and are therefore visible.
There are more sensitive nerves in this part of the body, so external hemorrhoids can be very
painful. Straining when passing stool may cause external or internal hemorrhoids to bleed.
Diagnosis
A doctor will likely ask about a person’s medical history and perform a physical examination and
other tests to check for hemorrhoids. They will examine the area surrounding the anus for
external hemorrhoids, which involves looking for:
 lumps
 small tears in the anus
 irritated skin
 prolapsed internal hemorrhoids
They may also perform a digital rectal exam to diagnose internal hemorrhoids. This involves
manually inspecting the anus using a gloved, lubricated finger to check for blood, sensitivity, and
lumps.

27
 If a doctor does not find internal hemorrhoids with a digital rectal exam, they may use a small
device called an anoscope to check the anal and rectal lining. They may be able to view internal
hemorrhoids as bulges through the device.
Prevention
Lifestyle changes can help lower the risk of hemorrhoids. These include:
 Eating a healthy diet: Eating plenty of foods rich in fiber, such as fruits, vegetables, and whole
grains, can help keep stools soft. Taking OTC fiber supplements and staying hydrated can also
ease constipation.
 Avoiding straining: A person should try not to strain when using the toilet. Straining puts
pressure on the veins in the lower rectum.
 Going to the bathroom when needed: It is best to avoid waiting to use the toilet. The longer a
person waits, the drier the stools will be.
 Getting regular physical activity: Exercise helps stool move through the bowel, making bowel
movements more regular.
 Maintaining a moderate body weight: Being overweight raises the risk of having hemorrhoids.
Treatments
In most cases, simple measures will alleviate symptoms while hemorrhoids heal on their own.
However, medication or surgery may be necessary in certain cases.
Home treatments
The following home treatments may help relieve symptoms of hemorrhoids:
 Topical creams and ointments: Over-the-counter (OTC) creams for external hemorrhoids can
help reduce itching, discomfort, and swelling.
 Fiber supplements: Taking supplements like methylcellulose (Citrucel)
and psyllium (Metamucil) can reduce constipation and help with hemorrhoids.
 Ice packs and cold compresses: Applying these to the affected area may help ease pain.
 A sitz bath: A sitz bath involves sitting in a tub of shallow, warm water. Taking one a few times
each day may help reduce hemorrhoid pain.
 Analgesics: Painkillers such as aspirin, ibuprofen, and acetaminophen may help alleviate pain
from hemorrhoids.

28
 Medications
Hemorrhoid medications come in various forms, including suppositories, ointments, and pads. A
person can usually buy them over the counter.
Several common medications include:
 Zinc oxide: Creams containing zinc oxide may help with irritation. One ointment, Calmoseptine,
combines zinc oxide and menthol. It may be effectiveTrusted Source for relieving anal itching,
which can be related to hemorrhoids.
 Witch hazel: Experts say that astringents, such as witch hazel, may provide temporary relief.
 Steroid cream: Corticosteroids such as hydrocortisone are commonly used to treat hemorrhoids.
They can help reduce inflammation, but they may damage the skin if used for too long.
 Lidocaine: Lidocaine acts as a local anesthetic. ResearchTrusted Source suggests that creams or
suppositories that combine tribenoside (an anti-inflammatory) with lidocaine may help improve
symptoms of pain and itching.
A person should talk with a doctor if symptoms do not improve after using these medications for
a week.
Nonsurgical treatment options
If home remedies do not improve hemorrhoids, a person may need further treatment.
Nonsurgical options includeTrusted Source:
 Rubber band ligation: This outpatient procedure for internal hemorrhoids involves placing an
elastic band on the base of the hemorrhoid to block its blood supply. The hemorrhoid will either
shrink or fall off.
 Sclerotherapy: During this procedure, doctors inject a liquid into an internal hemorrhoid. This
produces a scar that cuts off blood supply to the hemorrhoid, causing it to shrink.
 Infrared photocoagulation: Shining infrared light toward an internal hemorrhoid heats the area,
causing scar tissue to form. This blocks the hemorrhoid’s blood supply and reduces its size.
 Electrocoagulation: Doctors send a low electric current into a hemorrhoid to create scarring.
This scar tissue cuts off the blood supply, leading the hemorrhoid to shrink.
A doctor will usually carry out these procedures while the patient is under local anesthesia.
Surgical options
Surgery may involve the complete removal of external hemorrhoids or prolapsed internal
hemorrhoids. This procedure is known as a hemorrhoidectomy.

29
 Alternatively, a doctor or surgeon may staple a prolapsed hemorrhoid back into place in the anus.
During these procedures, a patient will receive general anesthesia. Most people can go home on
the same day as the surgery.
Prevention
Lifestyle changes can help lower the risk of hemorrhoids. These include:
 Eating a healthy diet: Eating plenty of foods rich in fiber, such as fruits, vegetables, and whole
grains, can help keep stools soft. Taking OTC fiber supplements and staying hydrated can also
ease constipation.
 Avoiding straining: A person should try not to strain when using the toilet. Straining puts
pressure on the veins in the lower rectum.
 Going to the bathroom when needed: It is best to avoid waiting to use the toilet. The longer a
person waits, the drier the stools will be.
 Getting regular physical activity: Exercise helps stool move through the bowel, making bowel
movements more regular.
 Maintaining a moderate body weight: Being overweight raises the risk of having hemorrhoids.
Outlook
Hemorrhoid symptoms often resolve on their own with conservative treatment, although there is
a 10–50%Trusted Source chance they will return. The chance of hemorrhoids returning after
surgery is less than 5%Trusted Source.
Complications can sometimes occur, such as:
 Bleeding: Anyone with persistent or heavy bleeding, with or without pain, should seek
immediate medical help.
 Strangulated hemorrhoid: Muscles around the anus may block the blood supply to a prolapsed
hemorrhoid. This can cause significant pain.
 Anemia: Significant, chronic blood loss from hemorrhoids can lead to anemia. This occurs when
there are not enough red blood cells circulating in the body.
 Blood clots: Blood will sometimes clot within a hemorrhoid. If the hemorrhoid is external, this
can be very painful. A surgeon may need to remove the blood clot.
 Infection: Ulceration and infection can occur after treatment.

30
 Urinary retention: Around 15%Trusted Source of people have difficulty passing urine after
surgery on internal hemorrhoids. After surgery for external hemorrhoids, urinary retention will
affect 30–50%Trusted Source of people.
It is important for a person to talk with a doctor if hemorrhoids show no improvement after a
week or if new hemorrhoids keep forming.
Medical attention may also be needed for significant anal pain, heavy rectal bleeding, or fever.
Besides hemorrhoids, conditions such as colorectal and anal cancers can cause bleeding from the
rectum.
PIONEERS
1. LOUIS PASTEUR
Early Life and Education
Pasteur was born in Dole, France, the middle child of five in a family that had for generations
been leather tanners. Young Pasteur’s gifts seemed to be more artistic than academic until near
the end of his years in secondary school. Spurred by his mentors’ encouragement, he undertook
rigorous studies to compensate for his academic shortcomings in order to prepare for the École
Normale Supérieure, the famous teachers’ college in Paris. He earned his master’s degree there
in 1845 and his doctorate in 1847
Study of Optical Activity
While waiting for an appropriate appointment Pasteur continued to work as a laboratory assistant
at the École Normale. There he made further progress on the research he had begun for his
doctoral dissertation investigating the ability of certain crystals or solutions to rotate plane-
polarized light clockwise or counterclockwise, that is, to exhibit “optical activity.” He was able
to show that in many cases this activity related to the shape of the crystals of a compound. He
also reasoned that there was some special internal arrangement to the molecules of such a
compound that twisted the light an “asymmetric” arrangement. This hypothesis holds an
important place in the early history of structural chemistry the field of chemistry that studies the
three-dimensional characteristics of molecules.
Fermentation and Pasteurization
Pasteur secured his academic credentials with scientific papers on this and related research and
was then appointed in 1848 to the faculty of sciences in Strasbourg and in 1854 to the faculty in
Lille. There he launched his studies on fermentation. Pasteur sided with the minority view among

31
his contemporaries that each type of fermentation is carried out by a living microorganism. At
the time the majority believed that fermentation was spontaneously generated by a series of
chemical reactions in which enzymes themselves not yet securely identified with life played a
critical role.

In 1857 Pasteur returned to the École Normale as director of scientific studies. In the modest
laboratory that he was permitted to establish there, he continued his study of fermentation and
fought long, hard battles against the theory of spontaneous generation. Figuring prominently in
early rounds of these debates were various applications of his pasteurization process, which he
originally invented and patented (in 1865) to fight the “diseases” of wine. He realized that these
were caused by unwanted microorganisms that could be destroyed by heating wine to a
temperature between 60° and 100°C. The process was later extended to all sorts of other
spoilable substances such as milk.
Germ Theory
At the same time Pasteur began his fermentation studies, he adopted a related view on the cause
of diseases. He and a minority of other scientists believed that diseases arose from the activities
of microorganisms—germ theory. Opponents believed that diseases, particularly major killer
diseases, arose in the first instance from a weakness or imbalance in the internal state and quality
of the afflicted individual. In an early foray into the causes of particular diseases, in the 1860s,
Pasteur was able to determine the cause of the devastating blight that had befallen the silkworms
that were the basis for France’s then-important silk industry. Surprisingly, he found that the
guilty parties were two microorganisms rather than one.
A New Laboratory
Pasteur did not, however, fully engage in studies of disease until the late 1870s, after several
cataclysmic changes had rocked his life and that of the French nation. In 1868, in the middle of
his silkworm studies, he suffered a stroke that partially paralyzed his left side. Soon thereafter, in
1870, France suffered a humiliating defeat at the hands of the Prussians, and Emperor Louis-
Napoléon was overthrown. Nevertheless, Pasteur successfully concluded with the new
government negotiations he had begun with the emperor. The government agreed to build a new
laboratory for him, to relieve him of administrative and teaching duties, and to grant him a

32
pension and a special recompense in order to free his energies for studies of diseases.

Attenuating Microbes for Vaccines: Fowl Cholera and Anthrax

In his research campaign against disease Pasteur first worked on expanding what was known
about anthrax, but his attention was quickly drawn to fowl cholera. This investigation led to his
discovery of how to make vaccines by attenuating, or weakening, the microbe involved. Pasteur
usually “refreshed” the laboratory cultures he was studying in this case, fowl cholera every few
days; that is, he returned them to virulence by reintroducing them into laboratory chickens with
the resulting onslaught of disease and the birds’ death. Months into the experiments, Pasteur let
cultures of fowl cholera stand idle while he went on vacation. When he returned and the same
procedure was attempted, the chickens did not become diseased as before. Pasteur could easily
have deduced that the culture was dead and could not be revived, but instead he was inspired to
inoculate the experimental chickens with a virulent culture. Amazingly, the chickens survived
and did not become diseased; they were protected by a microbe attenuated over time.
Realizing he had discovered a technique that could be extended to other diseases, Pasteur
returned to his study of anthrax. Pasteur produced vaccines from weakened anthrax bacilli that
could indeed protect sheep and other animals. In public demonstrations at Pouilly-le-Fort before
crowds of observers, twenty-four sheep, one goat, and six cows were subjected to a two-part
course of inoculations with the new vaccine, on May 5, 1881, and again on May 17. Meanwhile
a control group of twenty-four sheep, one goat, and four cows remained unvaccinated. On May
31 all the animals were inoculated with virulent anthrax bacilli, and two days later, on June 2, the
crowd reassembled. Pasteur and his collaborators arrived to great applause. The effects of the
vaccine were undeniable: the vaccinated animals were all alive. Of the control animals all the
sheep were dead except three wobbly individuals who died by the end of the day, and the four
unprotected cows were swollen and feverish. The single goat had expired too.
Rabies and the Beginnings of the Institute Pasteur
Pasteur then wanted to move into the more difficult area of human disease, in which ethical
concerns weighed more heavily. He looked for a disease that afflicts both animals and humans so
that most of his experiments could be done on animals, although here too he had strong
reservations. Rabies, the disease he chose, had long terrified the populace, even though it was in
fact quite rare in humans. Up to the time of Pasteur’s vaccine, a common treatment for a bite by

33
a rabid animal had been cauterization with a red-hot iron in hopes of destroying the unknown
cause of the disease, which almost always developed anyway after a typically long incubation
period.
Rabies presented new obstacles to the development of a successful vaccine, primarily because
the microorganism causing the disease could not be specifically identified; nor could it be
cultured in vitro (in the laboratory and not in an animal). As with other infectious diseases, rabies
could be injected into other species and attenuated. Attenuation of rabies was first achieved in
monkeys and later in rabbits. Meeting with success in protecting dogs, even those already bitten
by a rabid animal, on July 6, 1885, Pasteur agreed with some reluctance to treat his first human
patient, Joseph Meister, a nine-year-old who was otherwise doomed to a near-certain death.
Success in this case and thousands of others convinced a grateful public throughout the world to
make contributions to the Institut Pasteur. It was officially opened in 1888 and continues as one
of the premier institutions of biomedical research in the world. Its tradition of discovering and
producing vaccines is carried on today by the pharmaceutical company Sanofi Pasteur.
A Great Experimenter and Innovative Theorist
Pasteur’s career shows him to have been a great experimenter, far less concerned with the theory
of disease and immune response than with dealing directly with diseases by creating new
vaccines. Still it is possible to discern his notions on the more abstract topics. Early on he linked
the immune response to the biological, especially nutritional, requirements of the
microorganisms involved; that is, the microbe or the attenuated microbe in the vaccine depleted
its food source during its first invasion, making the next onslaught difficult for the microbe.
Later he speculated that microbes could produce chemical substances toxic to themselves that
circulated throughout the body, thus pointing to the use of toxins and antitoxins in vaccines. He
lent support to another view by welcoming to the Institut Pasteur Élie Metchnikoff and his theory
that “phagocytes” in the blood—white corpuscles—clear the body of foreign matter and are the
prime agents of immunity.

2. ANTONIE VAN LEEUWENHOEK

Antonie van Leeuwenhoek, (born October 24, 1632, Delft, Netherlands—died August 26, 1723,
Delft), Dutch microscopist who was the first to observe bacteria and protozoa. His researches on

34
lower animals refuted the doctrine of spontaneous generation, and his observations helped lay the
foundations for the sciences of bacteriology and protozoology.
Early life and career

At a young age, Leeuwenhoek lost his biological father. His mother later married painter Jacob
Jansz Molijn. When his stepfather died in 1648, Leeuwenhoek was sent to Amsterdam to become
an apprentice to a linen draper. Returning to Delft when he was 20, he established himself as a
draper and haberdasher. He was married in 1654 to a draper’s daughter. By the time of her death,
in 1666, the couple had five children, only one of whom survived childhood. Leeuwenhoek
remarried in 1671; his second wife died in 1694.

In 1660 Leeuwenhoek obtained a position as chamberlain to the sheriffs of Delft. His income
was thus secure, and it was thereafter that he began to devote much of his time to his hobby of
grinding lenses and using them to study tiny objects.
Discovery of microscopic life

Leeuwenhoek made microscopes consisting of a single high-quality lens of very short focal
length; at the time, such simple microscopes were preferable to the compound microscope,
which increased the problem of chromatic aberration. Although Leeuwenhoek’s studies lacked
the organization of formal scientific research, his powers of careful observation enabled him to
make discoveries of fundamental importance. In 1674 he likely observed protozoa for the first
time and several years later bacteria. Those “very little animalcules” he was able to isolate from
different sources, such as rainwater, pond and well water, and the human mouth and intestine. He
also calculated their sizes.

In 1677 he described for the first time the spermatozoa from insects, dogs, and humans, though
Stephen Hamm probably was a codiscoverer. Leeuwenhoek studied the structure of the optic
lens, striations in muscles, the mouthparts of insects, and the fine structure of plants and
discovered parthenogenesis in aphids. In 1680 he noticed that yeasts consist of minute globular
particles. He extended Marcello Malpighi’s demonstration in 1660 of the blood capillaries by
giving the first accurate description of red blood cells. In his observations on rotifers in 1702,
Leeuwenhoek remarked that

35
in all falling rain, carried from gutters into water-butts, animalcules are to be found; and that in
all kinds of water, standing in the open air, animalcules can turn up. For these animalcules can
be carried over by the wind, along with the bits of dust floating in the air.
The Royal Society and later discoveries

A friend of Leeuwenhoek put him in touch with the Royal Society of England, to which he
communicated by means of informal letters from 1673 until 1723 most of his discoveries and to
which he was elected a fellow in 1680. His discoveries were for the most part made public in the
society’s Philosophical Transactions. The first representation of bacteria is to be found in a
drawing by Leeuwenhoek in that publication in 1683.

His researches on the life histories of various low forms of animal life were in opposition to the
doctrine that they could be produced spontaneously or bred from corruption. Thus, he showed
that the weevils of granaries (in his time commonly supposed to be bred from wheat as well as in
it) are really grubs hatched from eggs deposited by winged insects. His letter on the flea, in
which he not only described its structure but traced out the whole history of its metamorphosis, is
of great interest, not so much for the exactness of his observations as for an illustration of his
opposition to the spontaneous generation of many lower organisms, such as “this minute and
despised creature.” Some theorists asserted that the flea was produced from sand, others from
dust or the like, but Leeuwenhoek proved that it bred in the regular way of winged insects.
Leeuwenhoek carefully studied the history of the ant and was the first to show that what had
been commonly reputed to be ants’ eggs were really their pupae, containing the
perfect insect nearly ready for emergence, and that the true eggs were much smaller and gave
origin to maggots, or larvae. He argued that the sea mussel and other shellfish were not generated
out of sand found at the seashore or mud in the beds of rivers at low water but from spawn, by
the regular course of generation. He maintained the same to be true of the freshwater mussel,
whose embryos he examined so carefully that he was able to observe how they were consumed
by “animalcules,” many of which, according to his description, must have included ciliates in
conjugation, flagellates, and the Vorticella. Similarly, he investigated the generation of eels,
which were at that time supposed to be produced from dew without the ordinary process of
generation. The dramatic nature of his discoveries made him famous, and he was visited by

36
many notables—including Peter I (the Great) of Russia, James II of England, and Frederick
II (the Great) of Prussia.
Methods of microscopy

Leeuwenhoek’s methods of microscopy, which he kept secret, remain something of a mystery.

During his lifetime he ground more than 500 lenses, most of which were very small—some no
larger than a pinhead—and usually mounted them between two thin brass plates, riveted
together. A large sample of those lenses, bequeathed to the Royal Society, were found to have
magnifying powers in the range of 50 to, at the most, 300 times. In order to observe phenomena
as small as bacteria, Leeuwenhoek must have employed some form of oblique illumination, or
other technique, for enhancing the effectiveness of the lens, but this method he would not reveal.
Leeuwenhoek continued his work almost to the end of his long life of 90 years.
Contributions to scientific literature

Leeuwenhoek’s contributions to the Philosophical Transactions amounted to 375 and those to

the Memoirs of the Paris Academy of Sciences to 27. Two collections of his works appeared
during his life, one in Dutch (1685–1718) and the other in Latin (1715–22); a selection was
translated by Samuel Hoole, The Select Works of A. van Leeuwenhoek (1798–1807).

37