BACKGROUND:

Amoebiasis is an intestinal illness that's typically transmitted when someone eats or

drinks something that's contaminated with a microscopic parasite called Entamoeba
histolytica (E. histolytica). The parasite is an amoeba, a single-celled organism. That's
how the illness got its name — amoebiasis.

CAUSATIVE AGENT:

Amoebic dysentery is an intestinal infection caused by a protozoan parasite

called Entamoeba histolytica.
SYMPTOMS/EFFECTS:

Infection by Entamoeba histolytica may be asymptomatic. The symptoms of

amoebic dysentery include fever, chills, diarrhea, abdominal pain, and passing stool with
blood and/or mucus, etc. Entamoeba histolytica may invade the liver to form an abscess.
Less commonly, it spreads to other parts of the body, such as the lungs or brain. Other
complications include inflammation of the intestine and in severe cases, perforation.

MODE OF TRANSMISSION:

Transmission of amoebic dysentery occurs mainly through fecal-oral route

including ingestion of fecal contaminated food or water containing the cyst of Entamoeba
histolytica. Transmission can also occur through person-to-person contact such as diaper-
changing and oral-anal sex.
INCUBATION PERIOD:
The incubation period is variable, and may range from a few days to several
months. It is usually 2 - 4 weeks.

RISK FACTORS:
People who live in institutions, travelers who travel to or immigrants from
developing countries with poor sanitary conditions, and men who have sex with men are
at a higher risk of getting the disease.

OCCURENCES:
It occurs worldwide but most common in the tropics and subtropics. It is
prevalent in areas with poor sanitation.

DRUG OF CHOICE:
Metronidazole
FACTORS TO PREVENT/CURE THE DISEASE:

a. Pharmacological Means:

Asymptomatic infection should be treated luminal agents that are minimally

absorbed by the GIT (e.g. Paramomycin, Iodoquinol, Diloxanide Furoate).
Metronidazole is the mainstay of therapy for invasive amoebiasis. Tinidazole has
been approved by the US Food and Drug administration for intestinal or extra-intestinal.

b. Non-Pharmacological Means:

 Maintain good personal, food and environmental hygiene.

 Wash hands thoroughly with liquid soap and water before handling food or eating, and
after using toilet.
 Drink only boiled water from the mains or bottled drinks from reliable sources.

 Eat only thoroughly cooked food.

BACKGROUND:
Cholera is an intestinal infection caused by Vibrio cholerae (see the images
below). 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 still 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.

CAUSATIVE AGENT:
Vibrio cholerae, the causative organism of the disease cholera and the producer
of several different toxins, belongs to the family Vibrionaceae, the genus Vibrio and the
species V. cholerae.
SYMPTOMS:
Cholera is an extremely virulent disease that can cause severe acute watery
diarrhea. It takes between 12 hours and 5 days for a person to show symptoms after
ingesting contaminated food or water. Cholera affects both children and adults and can
kill within hours if untreated.
Most people infected with V. cholerae do not develop any symptoms, although the
bacteria are present in their feces for 1-10 days after infection and are shed back into the
environment, potentially infecting other people.

MODE OF TRANSMISSION:
Transmission occurs through the ingestion of contaminated water or food. Sudden
large outbreaks are usually caused by a contaminated water supply. Outbreaks and
endemic and sporadic cases are often attributed to raw or undercooked seafood. Direct
person-to-person transmission is rare.
INCUBATION PERIOD:
The incubation period is from a few hours to 5 days; it is usually 2–3 days.

RISK FACTORS:
Children and older people are most at risk of infection. Even in severe epidemics,
clinically apparent disease rarely occurs in more than 2 per cent of those at risk. Gastric
achlorhydria (the absence of hydrochloric acid in the gastric secretions of the stomach)
or other causes of high gastric pH increase the risk of disease. There is some evidence
that breastfeeding reduces the risk of infection.
Infection results in a rise in antibodies with increased resistance to reinfection.

OCCURRENCES:
Cholera can be endemic or epidemic. A cholera-endemic area is an area where
confirmed cholera cases were detected during the last 3 years with evidence of local
transmission. A cholera outbreak/epidemic can occur in both endemic countries and in
countries where cholera does not regularly occur.
FACTORS TO PREVENT/CURE THE DISEASE:

a. Pharmacological Means:
Tetracycline has been shown to be effective treatment for cholera, and is superior
to Furazolidone, Cholamphenicol and Sulfaguanidine in reducing cholera morbidity.
Treatment with a single 300mg dose of doxycycline has shown to be equivalent to
tetracycline treatment. Erythromycin is effective for cholera treatment, and appropriate for
children and pregnant women.

b. Non-Pharmacological Means:
 Drink and use safe water.

 Wash your hands often with soap and safe water.

 Use latrines or bury your feces (poop); do not defecate in any body of water.

 Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and
vegetables.
 Clean up safely—in the kitchen and in places where the family bathes and washes
clothes.
BACKGROUND:
Diarrheal disease is the second leading cause of death in children under five
years old, and is responsible for killing around 525,000 children every year. Diarrhea can
last several days, and can leave the body without the water and salts that are necessary
for survival. In the past, for most people, severe dehydration and fluid loss were the main
causes of diarrhea deaths. Now, other causes such as septic bacterial infections are likely
to account for an increasing proportion of all diarrhea-associated deaths. Children who
are malnourished or have impaired immunity as well as people living with HIV are most
at risk of life-threatening diarrhea.
CAUSATIVE AGENT/S:
Acute diarrhea can be caused by a number of different agents. Common infective
causative agents include bacteria such as Vibrio parahaemolyticus and Salmonella, and
viruses such as norovirus, rotavirus and sapovirus. Less common causative agents include
those bacteria causing cholera, bacillary dysentery and Shiga toxin-producing Escherichia
coli infection, etc.

SYMPTOMS:
Patients with acute diarrheal diseases present with sudden onset of frequent loose
or watery stools, often accompanied by vomiting and fever. The disease is usually mild
with spontaneous recovery. Dehydration and shock may occur in severe cases.

MODE OF TRANSMISSION:
Acute diarrheal diseases usually spread by contaminated hands or ingestion of
contaminated food or drinks, and occasionally by aerosol spread with contaminated
droplets of splashed vomitus. Outbreaks may occur in settings like institutions and child
care centers.
INCUBATION PERIOD:
The incubation period is usually a few hours to 5 days after exposure for bacterial
diarrhea and 1 - 3 days for viral diarrhea.

RISK FACTORS:
Age: Diarrhea in children aged three years or younger can be highly dangerous, as
they are particularly vulnerable to dehydration. Newborns to two-month-old babies are at
highest risk. Elderly patients are also vulnerable to dehydration.
Environment: Poor sanitation and hygiene

OCCURRENCES:
Diarrheal disease is a leading cause of child mortality and morbidity in the world,
and mostly results from contaminated food and water sources. Worldwide, 780 million
individuals lack access to improved drinking-water and 2.5 billion lack improved
sanitation. Diarrhea due to infection is widespread throughout developing countries.
FACTORS TO PREVENT/CURE THE DISEASE:

a. Pharmacological Means:
Loperamide, or Imodium, is an antimotility drug that reduces stool
passage. Loperamide and Imodium are both available to purchase over-the-counter or
online.
Antibiotics are only used to treat diarrhea caused by a bacterial infection. If the
cause is a certain medication, switching to another drug might be possible.

b. Non-Pharmacological Means:
 access to safe drinking-water;

 use of improved sanitation;

 hand washing with soap;

 exclusive breastfeeding for the first six months of life;

 good personal and food hygiene;

 health education about how infections spread; and

 rotavirus vaccination.
BACKGROUND:
Escherichia coli (E. coli) bacteria normally live in the intestines of healthy
people and animals. Most varieties of E. coli are harmless or cause relatively brief
diarrhea. But a few particularly nasty strains, such as E. coli O157:H7, can cause
severe abdominal cramps, bloody diarrhea and vomiting.

CAUSATIVE AGENT:
Escherichia coli (E. coli) is a bacterium that is commonly found in the gut of
humans and warm-blooded animals. Most strains of E. coli are harmless. Some
strains, however, such as Shiga toxin-producing E. coli (STEC), can produce powerful
toxins and cause severe foodborne disease.
SYMPTOMS:
 Diarrhea, which may range from mild and watery to severe and bloody

 Abdominal cramping, pain or tenderness

 Nausea and vomiting, in some people

MODE OF TRANSMISSION:
An increasing number of outbreaks are associated with the consumption of fruits
and vegetables (including sprouts, spinach, lettuce, coleslaw, and salad) whereby
contamination may be due to contact with feces from domestic or wild animals at some
stage during cultivation or handling. STEC has also been isolated from bodies of water
(such as ponds and streams), wells and water troughs, and has been found to survive for
months in manure and water-trough sediments. Waterborne transmission has been
reported, both from contaminated drinking-water and from recreational waters.

INCUBATION PERIOD:
The incubation period is usually 3-4 days after the exposure, but may be as short
as 1 day or as long as 10 days.
RISK FACTORS
E. coli can affect anyone who is exposed to the bacteria. But some people are more likely to
develop problems than are others. Risk factors include:
 Age. Young children and older adults are at higher risk of experiencing illness caused by E. coli and
more-serious complications from the infection.
 Weakened immune systems. People who have weakened immune systems — from AIDS or drugs to
treat cancer or prevent the rejection of organ transplants — are more likely to become ill from
ingesting E. coli.
 Eating certain types of food. Riskier foods include undercooked hamburger; unpasteurized milk, apple
juice or cider; and soft cheeses made from raw milk.
 Decreased stomach acid levels. Stomach acid offers some protection against E. coli. If you take
medications to reduce your levels of stomach acid, such as esomeprazole (Nexium), pantoprazole
(Protonix), lansoprazole (Prevacid) and omeprazole (Prilosec), you may increase your risk of an E. coli
infection.

OCCURENCES:
Sources of E. coli. E. coli O157:H7 is most commonly found in cows, although
chickens, deer, sheep, and pigs have also been known to carry it. Meat becomes
contaminated during slaughter, when infected animal intestines or feces come in contact
with the carcass.
FACTORS TO PREVENT/CURE THE DISEASE:

a. Pharmacological Means:
The mainstay of treatment for EHEC infection is supportive. Although E. coli is
sensitive to most commonly used antibiotics, antibiotics have not been shown to
alleviate symptoms, reduce carriage of the organism, or prevent hemolytic-uremic
syndrome. Fluoroquinolones are suspected of increasing release of enterotoxins and
the risk of hemolytic-uremic syndrome.

b. Non-Pharmacological Means:
 Wash utensils. Use hot soapy water on knives, countertops and cutting boards before
and after they come into contact with fresh produce or raw meat.
 Keep raw foods separate. This includes using separate cutting boards for raw meat and
foods, such as vegetables and fruits. Never put cooked hamburgers on the same plate
you used for raw patties.
 Wash your hands. Wash your hands after preparing or eating food, using the toilet, or
changing diapers. Make sure that children also wash their hands before eating, after
using the bathroom and after contact with animals.
BACKGROUND:
Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is
primarily spread when an uninfected (and unvaccinated) person ingests food or
water that is contaminated with the feces of an infected person. The disease is
closely associated with unsafe water or food, inadequate sanitation and poor
personal hygiene.
Hepatitis A infection can cause debilitating symptoms and fulminant
hepatitis (acute liver failure), which is often fatal.

CAUSATIVE AGENT:
Hepatitis A virus (HAV), a hepatovirus from the Picornaviridae family, is the
causative agent, primarily through the fecal–oral route.
SYMPTOMS:
Symptoms of hepatitis A range from mild to severe, and can include fever,
malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine
and jaundice (a yellowing of the skin and whites of the eyes). Not everyone who is
infected will have all of the symptoms.

MODE OF TRANSMISSION:
The hepatitis A virus is transmitted primarily by the fecal-oral route; that is
when an uninfected person ingests food or water that has been contaminated with the
feces of an infected person. In families, this may happen though dirty hands when an
infected person prepares food for family members. Waterborne outbreaks, though
infrequent, are usually associated with sewage-contaminated or inadequately treated
water.
The virus can also be transmitted through close physical contact with an
infectious person, although casual contact among people does not spread the virus.

INCUBATION PERIOD:
The incubation period of hepatitis A is usually 14–28 days.
RISK FACTORS
Anyone who has not been vaccinated or previously infected can get infected with
hepatitis A virus. In areas where the virus is widespread (high endemicity), most hepatitis
A infections occur during early childhood. Risk factors in intermediate and high
endemicity areas include:
 poor sanitation;

 lack of safe water;

 use of recreational drugs;

 living in a household with an infected person;

 being a sexual partner of someone with acute hepatitis A infection; and

 travelling to areas of high endemicity without being immunized.

OCCURENCES:
Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for
cyclic recurrences. The hepatitis A virus is one of the most frequent causes of foodborne
infection. Epidemics related to contaminated food or water can erupt explosively, such as
the epidemic in Shanghai in 1988 that affected about 300 000 people.
FACTORS TO PREVENT/CURE THE DISEASE:

 Pharmacological Means:
There is no specific treatment for hepatitis A. Recovery from symptoms following infection
may be slow and may take several weeks or months. Most important is the avoidance of unnecessary
medications. Acetaminophen / Paracetamol and medication against vomiting should not be given.
Hospitalization is unnecessary in the absence of acute liver failure. Therapy is aimed at
maintaining comfort and adequate nutritional balance, including replacement of fluids that are lost
from vomiting and diarrhea.

b. Non-Pharmacological Means:
 Improved sanitation, food safety and immunization are the most effective ways to combat hepatitis A.

 The spread of hepatitis A can be reduced by:

 adequate supplies of safe drinking water;

 proper disposal of sewage within communities; and

 personal hygiene practices such as regular hand-washing with safe water.

 Several injectable inactivated hepatitis A vaccines are available internationally. All are similar in terms
of how well they protect people from the virus and their side-effects.
BACKGROUND:
Typhoid fever is caused by Salmonella typhi bacteria. Typhoid fever is rare in
industrialized countries. However, it remains a serious health threat in the developing
world, especially for children.
Typhoid fever spreads through contaminated food and water or through close
contact with someone who's infected. Signs and symptoms usually include a high fever,
headache, abdominal pain, and either constipation or diarrhea.

CAUSATIVE AGENT:
Salmonella typhi, the causative agent of typhoid fever, is approximately 50,000
years old.
SYMPTOMS:
Early illness
 Once signs and symptoms do appear, you're likely to experience:
 Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
 Headache
 Weakness and fatigue
 Muscle aches
 Sweating
 Dry cough
 Loss of appetite and weight loss
 Abdominal pain
 Diarrhea or constipation
 Rash
 Extremely swollen abdomen
Later illness
 If you don't receive treatment, you may:
 Become delirious
 Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state
MODE OF TRANSMISSION:
Fecal-oral transmission route
 The bacteria that cause typhoid fever spread through contaminated food or water and occasionally
through direct contact with someone who is infected. In developing nations, where typhoid fever
is established (endemic), most cases result from contaminated drinking water and poor sanitation.
The majority of people in industrialized countries pick up typhoid bacteria while traveling and
spread it to others through the fecal-oral route.
Typhoid carriers
 Even after treatment with antibiotics, a small number of people who recover from typhoid fever
continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These
people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others,
although they no longer have signs or symptoms of the disease themselves.

INCUBATION PERIOD:

Incubation period for Salmonella typhi and Salmonella paratyphi. The incubation
differs for typhoid and paratyphoid fever: The incubation period for typhoid fever is
usually 8–14 days, but this depends on the infective dose and can vary from 3 days to 1
month
RISK FACTORS:
 Worldwide, children are at greatest risk of getting the disease, although they generally have milder
symptoms than adults do.
 If you live in a country where typhoid fever is rare, you're at increased risk if you:

 Work in or travel to areas where typhoid fever is established (endemic)

 Work as a clinical microbiologist handling Salmonella typhi bacteria

 Have close contact with someone who is infected or has recently been infected with typhoid fever

 Drink water contaminated by sewage that contains Salmonella typhi.

OCCURENCES:
Typhoid fever remains a serious worldwide threat — especially in the developing world —
affecting an estimated 26 million or more people each year. The disease is established (endemic) in
India, Southeast Asia, Africa, South America and many other areas.

DRUG OF CHOICE:
With appropriate antibiotic therapy, there is usually improvement within one to two days
and recovery within seven to 10 days. Several antibiotics are effective for the treatment of typhoid
fever. Chloramphenicol was the original drug of choice for many years
FACTORS TO PREVENT/CURE THE DISEASE:

a. Pharmacological Means:
Vaccines:
Two vaccines are available: One is injected in a single dose at least one week before travel. One is
given orally in four capsules, with one capsule to be taken every other day.
Neither vaccine is 100 percent effective, and both require repeat immunizations, as vaccine
effectiveness diminishes over time.

b. Non-Pharmacological Means:
 Wash your hands. Frequent hand-washing in hot, soapy water is the best way to control infection. Wash before
eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water
isn't available.
 Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid
fever is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and
beer. Carbonated bottled water is safer than uncarbonated bottled water is.
 Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.

 Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and
vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
 Choose hot foods. Avoid food that's stored or served at room temperature. Steaming hot foods are best. And
although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from
street vendors — it's more likely to be contaminated.