EDEN UNIVERSITY

SCHOOL OF MEDICINE
COMMUNICABLE DISEASES

Dr FRANCIS KIESE NGEMBA

I. Definition
 Communicable Disease is one that can transmitted from one person to
another and is caused by an infectious agent that is transmitted from a
source or reservoir to a susceptible host.

 Communicable disease is one in which the causative organism or

pathogen is carried from one person to another either directly or
indirectly.

 Communicable diseases are also referred to as Infectious Disease

 Virulence: Is the degree of pathogenicity of an organism, i.e. the

relative ability of a pathogen to cause disease. Not all pathogens
entering human body will cause disease because humans are
protected by normal flora and the immune system
No Infectious Agents Diseases

1. Viruses Common Cold, Influenza, Measles, Mumps, Varicella, HIV, Hepatitis B/C

2 Bacteria Cholera, typhoid, TB, tetanus, anthrax…

3 Fungi Skin fungal infections

4 Protozoans Malaria, Kala-Azar, Amoebiasis, African Human Trypanosomiasis

5 Helminths Intestinal infestation, Elephantiasis

Epidemiological Model of Disease Causation
II. Pathophysiology of Communicable Diseases
 Course of Infectious Diseases
There are 4 phases or periods in any infectious disease:

1. The incubation period: The time between entry of the pathogen and the
onset of symptoms.

2. The prodromal period: The time when the person feels abnormal and
weak.

3. The period of illness: The time when the person feels typical symptoms
associated with that specific disease.

4. The convalescent period: The time when the person recovers from the
infection but may develop permanent damage to the area of infection
 Localized vs Systemic Infection
1. Localized Infection: The pathogen is only present at the original site of
infection.
2. Systemic Infection (Generalized): The pathogen is carried to other
parts of the body by blood, lymph.
 Acute, Subacute and Chronic Disease
1. Acute Disease: Rapid onset of disease and rapid recovery. e.g.
Influenza, measles
2. Subacute Disease: The disease with onset less than acute but more
than chronic. e.g. bacterial endocarditis.
3. Chronic Disease: Slow onset of disease and last a long time. e.g. Tb,
syphilis.
 Steps in the pathogenesis of Infectious Diseases
1. Entry
2. Attachment
3. Colonization
4. Invasion
5. Immune response Inhibitors
6. Toxins..
 Ways or Portals of Pathogens’ Entry
1. Penetration of Skin. e.g. Bilharzia

2. Through mucous membranes:

- Ingestion (Gastrointestinal tract),
- Inhalation (Respiratory tract),
- Introducing pathogen into Genitourinary tract or blood, or
- by insects bite e.g. Malaria
 Attachment (Adhesion)
 Microorganisms have macromolecules (proteins or carbohydrates) that promote
attachment to tissue surfaces.
 Viruses and many bacteria must first bind to host cell surfaces.
 Prevents early clearance.
 Pathogens often bind host tissues via surface receptors. e.g. pili in bacteria.
 Adhesins: This have been shown to be important in a number of microorganisms.
Streptococcus mutans, a member of the normal oral flora, produces a polysaccharide,
dextran, that enhances its attachment to teeth. Pathogenic strains of Escherichia coli
have pili that aid in attachment to epithelial cells of the gastrointestinal tract or urinary
tract
 Colonization
1. Some virulent bacteria produce special proteins that allow them to colonize parts of
the host body.
2. Pathogens start multiplication and maintenance.
3. Pathogens compete with normal flora for residence.
4. Pathogens will resist body reactions e.g. Bile, stomach acid, skin secretions, IgA
(mucosal antibodies). e.g. Helicobacter pylori is able to survive in the acidic
environment of the human stomach by producing the enzyme urease
 Invasion
 Some virulent bacteria produce proteins that either:
a. Disrupt host cell membranes
b. Stimulate endocytosis into host cells. Endocytosis is the process by which cells
absorb material (molecules such as proteins) from outside the cell by engulfing
it with their cell membrane
 Immune Response Inhibitors
 Many bacteria produce virulence factors that inhibit the host's immune system
defenses.

 The polysaccharide capsule of Streptococcus pneumoniae inhibits phagocytosis of

the bacterium by host immune cells.
 Bacterial toxins
 Many virulence factors are proteins made by microorganisms that poison host cells
and cause tissue damage. e.g. Bacteria that produce toxins are called toxigenic
III. Types of Communicable Diseases
Depending on the source,

 Respiratory Infections

 Intestinal Infections

 Arthropods borne infection

 Surface infections

 Sexually Transmitted Infections/Diseases

 Respiratory Infections
 Respiratory Infections Are caused by germs — viruses,
bacteria or other pathogenic microbes.

 Germs that can infect the respiratory system (lungs, throat,

airways) can often be spread through mucus and saliva (also
known as "respiratory secretions") expelled when a person
coughs, sneezes, talks or laughs.

 Some of these germs are spread through droplets small

enough to remain suspended in the air and travel over long
distance
Some examples of the Respiratory Diseases are :

1. Tuberculosis
2. Chicken pox
3. Measles
4. Influenza
5. Diphtheria
6. Whooping cough
 Tuberculosis

 Specific infectious disease primarily affecting the lungs

(Pulmonary tuberculosis-most common).
 It also affects all other vital organs like intestine, brain,
bones, joints, lymph glands, skin etc.
 Incubation period: – From weeks, months to years depending
upon dose of infection & immunity of patient.
 Mode of Transmission Tuberculosis is mainly spread by
. Droplet infection (Produced by sputum of positive
patient)
. Coughing
 Sign & Symptoms
1. Tiredness
2. Loss of appetite
3. Loss of weight
4. Anemia
5. Evening rise in temperature
6. Prolonged Cough
 Prevention
1) Raising the resistance of the population to
the disease by:
i. Good social conditions: - Satisfactory
housing & adequate diet.
ii. BCG Vaccination: - After birth
2) Pasteurization of milk to eliminate tuberculosis
infection in milk
 Chicken Pox

 Also called Varicella

 Occur mainly in Children under 10 years of age.
 Uncommon in adults.
 Incubation Period : About 14 – 16 days.
 Mode of Transmission : Chicken pox is mainly spread
by
1. Droplet infection
2. Freshly contaminated fomites used by patients
can transmit disease.
3. Virus can cross placental barrier & may affect
fetus
 Sign & Symptoms
1. Fever
2. Appearance of rash in the form of crop on trunk,
face and limbs.
3. Macules (small flat colored spot on skin) appear
first, and with in 24 hrs, lesions are apparent.
4. then lesions becomes dry to form scabs
 Prevention
1.Use of local antiseptics like chlorhexidine.
2. If bacterial infection over adds give antibiotics.
3. Transmission prevented by isolation of patient
for 5-7 days.
4. Sterilization of all articles used by patient after
cure
 Measles
 Occur in children of 3-5 yrs of ages.
 Incubation Period : About 8–14 days.
 Mode of Transmission: measles are mainly spread by
1. Droplet infection
2. Direct contact

 Sign & Symptoms

- Stage 1(Catarrhal stage) Fever, Running nose,
Cough, appearance of red spot in mouth, watering
of eyes
- Stage 2 (Stage of eruption) Red rash seen at back
of ears & foreheads along hairline Rash spread all
over body.
 Prevention
1. Active immunization: By live attenuated measles virus over one
year age.
2. Passive immunization By Human normal immunoglobulin
 Arthropods borne Infections
 Arthropod Borne Infections Arthropod Borne Infectious
diseases are human illnesses caused by parasites, viruses
and bacteria that are transmitted by mosquitoes, sandflies,
bugs, blackflies, snails and lice.

 Every year there are more than 700 000 deaths from
diseases such as malaria, Plague etc..

 Some of the Arthropod Borne Infectious diseases are :

1.Malaria
2.Plague
3.Filariasis
 Malaria
 Occur in most topical regions.

 Protozoa disease (Protozoan infections are parasitic

diseases caused by organisms).

 Transmitted by bite of anopheles mosquitoes

 Incubation Period : About 9–30days.

 Mode of Transmission: Malaria is mainly spread by

1. Vector transmission: By bite of female anopheles
mosquito
2. Direct transmission: By injections of infected blood or
plasma
3. Congenital: Infected mother to new born
 Sign & Symptoms
1. general signs: Fever, coldness
Headaches, MJP, GBP, GBW
2. nausea, vomiting, diarrhea.
 Prevention
1. Prevention against mosquito bite
2. Anti larval measures
3. Anti adult mosquito measures
4. Control of human reservoir
5. Chemoprophylaxis
 Plague
 Zoonotic disease or zoonosis: infection transmitted to man
by infected rat fleas
 Vector - Rat
 Incubation Period : About 9–30days.
 Sign & Symptoms of Pneumonic Plague
1. general signs: Fever
2. CNS: headaches
3. Respiratory: cough, hemoptysis, dyspnea, chest
pain
4. Muscular: weakness
 Prevention:
- General measures: pest control, early diagnosis,
isolation of the cases, use of PPEs, etc.
- Chemoprophylaxis
- Vaccination
 Surface Infections

 An infection of the skin that can be caused by bacteria,

fungus, viruses or parasites.
 Example of Surface Infectious diseases:
1. Rabies
2. Trachoma
3. Leprosy
 Rabies

 Zoonotic disease
 Also called – Hydrophobia
 Caused by rabies virus that Infect CNS & salivary glands.
 Incubation Period: 9 days - 4 to 8 weeks.
- varies from patient to patient
- Shorter in children
- Also depends upon site of infection
. Face : 30 days
. Hands: 40 days
. Legs: 60 days
 Spreads by wide range of animals, mostly by bites or lick on
broken skin
 Prevention
o Pre-exposure prophylaxis:
- Risky persons like zoo keepers should be immunized.
- Compulsory vaccination of pets & stray dogs
o Post-exposure prophylaxis Prompt & proper
treatment
o Also take following measures:
- Wash area of bite using plenty of soap & water for
about 5 min.
- Apply antiseptics like tincture of iodine
- PE Vaccination: 1 ml vaccine at day 0,3,7,14, & 30
 Leprosy
 Also called Hansen's disease
 Chronic infections of human.
 Affect & damage superficial tissue especially skin and
peripheral nerves.
 Incubation Period : About 3–5 years
 Mode of Transmission: Mainly spread by
1. Direct transmission Prolonged close contact with an
infected person.
2. Through air borne droplets
 Sign & Symptoms
1. Initially nerve damage causes numbness of skin on
face, hands & feet.
2. Affected skin may become thickened & discolored.
3. Loss of sensation
4. Lack of sensation leads to injury or even loss of fingers
or toes
 Prevention
o Isolation of patient
o Early diagnosis & chemotherapy
o Treated with some specific drugs such as Dapsone.
o Create awareness about leprosy
- Avoid over crowding
- Bad personal hygiene
- Avoid of sharing of cloths etc
o For prophylactic purposes use BCG vaccine
 Common Sexually Transmitted Infections:
Modes of transmission and Complications

 STIs/STDs are a series of transmissible diseases which

infect humans though sexual activity or indirect contact
transmission.
 STIs/STDs can affect both genitourinary apparatus and many
other organs though lymphatic system or hematogenous
dissemination
 Major STIs/STDs
Type of Agent Name Disease

Human Papilloma virus Warts

Viruses Herpes simplex Herpes rash
Hepatitis B/C Hepatitis
Human Immunodeficiency Virus AIDS

Chlamydia Chlamydia infection

Bacteria Neisseria gonorrhea Gonorrhea
Treponema pallidum Syphilis
Hemophilus ducrei Chancroid

Fungi Candida albicans Candidiasis

Protozoans Trichomonas vaginalis Trichomoniasis

Insects Sarcoptes scabii Scabies

Causes of Genital Ulcers Causes of Genital discharges Causes of Vaginitis and genital Itchiness
(urethral/cervical)

Herpes Chlamydia Candidiasis

Syphilis Gonorrhea Trichomoniasis

Chancroid Candidiasis Bacterial vaginosis

 Syphilis
 Cause: Spirochete calledTreponema pallidum
 Clinical Manifestations:
Syphilis is a multi-stage disorder:

 Primary stage:
 Chancre is the main feature:
o Painless
o infectious
o Hard
o Single or multiple
 Erupts several days to few months after infection
 Affects Genitals, mouth, rectum, other areas
 Sometimes there is no chancre
 Ulcer heals; many may think there is no problem
 Secondary stage
 Infectious rash
 3-6 weeks following infection
 Involves hands, soles of feet; other areas
 Fever and flu-like symptoms may also be apparent
 Rash typically heals after several weeks
 Condylomata Lata: Wart-like lesions
 Latent Stage
 Infection hides in body, often central nervous system
 Infected person can remain in this stage for years
 There may be no symptoms for a long time
 Disease begins to attack organs
 Latent further divided into early, late, or unknown stages
based on when infection occurred
 Late/Tertiary Stage
Severe symptoms develop:
o paralysis/numbness
o blindness
o heart disease
o dementia
 Complications:
Late syphilis
Congenital syphilis
HIV transmission
 Investigations:
Dark Field exam:
o used to demonstrate the spirochete as shiny motile
spiral structures with a dark background
o usually positive in the primary and secondary stages
Serological test:
o Non specific: RPR(Rapid plasma reagin ),
VDRL((venereal disease research laboratories)
o Specific: MHA-TP(Microhemagglutination Assay for Treponema
pallidum Antibodies), IgG
 Treatment
Early syphilis: Benzathine penicillin G (Bicillin L-A) 2.4 million units IM x 1
Late latent: Benzathine penicillin G 2.4 million units IM per week x 3
Neurosyphilis and cardiovascular syphilis: Intravenous penicillin G
 Herpes

 Cause: Herpes simplex I and II

 Clinical Manifestations:
 Most common symptom is blisters
- First (primary) outbreak occurs within a few weeks of
contact
- May continue for a couple weeks, longer for those with
compromised immune system
- May feel painful, itchy, tingle/burn
 Flu-like symptoms (headache, fever, swollen lymph glands,
muscle aches, etc)
 Burning during urination
 Complications:
are very rare
Can spread to newborns at delivery
severe infection in immune compromised patients
 Investigations:
Viral culture: This test involves taking a tissue sample or scraping of the
sores for examination in the laboratory.
Polymerase chain reaction (PCR) test.
Blood test.
 Treatment
No cure
Antivirals shorten duration, reduce frequency and severity of
recurrences
- Acyclovir (Zovirax)
- Famcyclovir (Famvir)
- Valcyclovir (Valtrex)
- Different dosages for initial treatment vs. recurrent or suppressive
treatment
 Chancroid

 Cause: Hemophilus ducreyi

 Clinical Manifestations
Painful sore (may be multiple) that looks like chancre with soft
edges
M:F ratio 10:1
 Investigation: A definitive diagnosis of Chancroid requires
the identification of H. ducreyi on special culture media
 Treatment: Azithromycin, Ceftriaxone
 Causes of Genital Ulcers
 Herpes: Painful, blister, ulcer, shallow, multiple, recurrent
 Syphilis: Painless, single, not recurrent
 Chancroid: Painful , single or multiple, not recurrent
 Gonorrhea

 Cause: Neisseria gonorrhea, a Gram negative diplococci

 Clinical Manifestations
 Men:
- painful discharge from urethra
- Burning while urinating,
 Women:
- Pain when urinating.
- Vaginal discharge.
- Redness of the genital area
- often no symptoms
 Complications
 Women:
- Pelvic Inflammatory Disease (PID)
- Infertility
- ectopic pregnancy
 Men
- epididymitis.
- Infertility
 Infants:
- Eye infection "ophthalmia neonatorum"
 Investigations
Gram Stain
Culture
Non-culture tests
- DNA Probe test (GenProbe)
- PCR/LCR test
 Treatment: Antibiotics for gonorrhea
Cefixime 400 mg PO x 1
Ciprofloxacin (Cipro) 500 mg PO x 1
Azithromycin (Zithromax) 2 gm PO x 1 Ceftriaxone (Rocephin) 125 mg IM x 1
Always treat for chlamydia also
 Complications
 Women:
- Pelvic Inflammatory Disease (PID)
- Infertility
- ectopic pregnancy
 Men
- epididymitis.
- Infertility
 Infants:
- Eye infection "ophthalmia neonatorum"
 Investigations
Gram Stain
Culture
Non-culture tests
- DNA Probe test (GenProbe)
- PCR/LCR test
Treatment: Antibiotics for gonorrhea
Cefixime 400 mg PO x 1
Ciprofloxacin (Cipro) 500 mg PO x 1
Azithromycin (Zithromax) 2 gm PO x 1 Ceftriaxone
(Rocephin) 125 mg IM x 1
Always treat for chlamydia also
 Chlamydiasis

 Cause: Chlamydia trachomatis

 Symptoms
Symptoms generally appear within three weeks of infection
 Genital discharge: urethral scant clear discharge in men and
cervical discharge in women
 Pain during urination
 Usually no symptoms for men or women
 Complications
Women: Pelvic Inflammatory Disease (PID), Infertility, ectopic
pregnancy
Infants: Pneumonia at 6 week age, eye infection
 Investigations
 Culture
 Non-amplified tests
a. Enzyme Immunoassay (EIA), e.g. Chlamydiazyme
b. Nucleic Acid Hybridization (NA Probe), e.g. Gen-Probe Pace
 NA amplification assays
a. polymerase chain reaction (PCR)
b. ligase chain reaction (LCR)s
 Treatment :Antibiotics for Chlamydia
Azithromycin 1 gm PO x 1
Doxycycline 100 mg PO BID x 7 days
Communicate with sex partner
Sexual intercourse should be avoided until treatment plan is
finished
Condoms can help prevent the spread of chlamydia
 Human Papilloma virus (HPV)
 Cause: Human Papilloma virus(HPV). HPV is a Virus;
therefore, incurable. There are 200+ strains of HPV,
and 40+ HPV forms can be sexually transmitted
 Clinical Manifestations:
Sometimes HPV provides no symptoms
Most common symptom is genital warts
Appearing days, weeks or longer after infection
Less common among men
 Complications
Approximately 30 of the HPV strains are thought to
cause cervical cancer
HPV may also increase risk of vulvar, anal, and penile
cancer
 Investigations
 If genital warts aren't visible, you'll need one or more of the
following tests:
1. Vinegar (acetic acid) solution test: may help in identifying
difficult-to-see flat lesions.
2. Pap test: can reveal abnormalities that can lead to cancer.
3. DNA test: can recognize the DNA of the high-risk varieties of
HPV that have been linked to genital cancers.
 Treatment
Genital warts may disappear on their own
Topical ointments/creams provided by physician
Freezing/burning/laser treatments for smaller warts than
other conditions)
 Communicate with all sex partners regarding HPV
Refrain from sexual activity until warts are gone
Condoms may help prevent HPV transmission (less definite
 Prophylaxis
HPV Vaccines: for several HPV strains
Example: Gardasil
o 3 injections across 6 months
o Protects against four high-risk HPV types (6, 11, 16, 18)
 Bacterial Vaginosis
 Cause: Increase in Gardnerella vaginalis & others, or
decrease in lactobacilli
 Clinical Manifestations
Vaginal pain.
Appearance of an abundant vaginal discharge.
Burning sensation.
An unpleasant smelly vaginal discharge ( like fish)
 Complications:
Increases the possibility of getting infected with HIV
Offers more possibilities of catching other types of
sexually transmitted diseases such as herpes,
chlamydia or gonorrhoea.
In a pregnant woman, increases the risk of having a
premature birth.
 Investigations
Clue cells on wet mount: Clue cells = vaginal cells
covered with bacteria that are a sign of bacterial
vaginosis.
Positive "whiff test“
Vaginal pH: A vaginal pH of 4.5 or higher is a sign of
bacterial vaginosis.
 Treatment
Metronidazole (Flagyl) 500 mg BID x 7 days (oral tab).
Clindamycin(cream)
Tinidazole(oral tab)
High recurrence rate after treatment
 Investigations
 If genital warts aren't visible, you'll need one or more of the
following tests:
1. Vinegar (acetic acid) solution test: may help in identifying
difficult-to-see flat lesions.
2. Pap test: can reveal abnormalities that can lead to cancer.
3. DNA test: can recognize the DNA of the high-risk varieties of
HPV that have been linked to genital cancers.
 Treatment
Genital warts may disappear on their own
Topical ointments/creams provided by physician
Freezing/burning/laser treatments for smaller warts than
other conditions)
Syndromic Treatment fo STDs
This approach consists in treating STDs based on clinical
presentation when lab investigations cannot be done

 Genital ulcer  treat for syphilis

Benzathine penicillin 2.4 million units IM

 Urethral discharge/cervical discharge  treat for gonorrhea

and chlamydia: Cefixime 400 mg or Cipro 500 mg +
Azithromycin 1.0 gm or Doxycycline 100 mg b.i.d. x 7 days

 Vaginal discharge in female  treat for trichomoniasis and

bacterial vaginosis: Metronidazole 2 gm
Thank you!!