Exam Study Guide - Cholera, Influenza, HIV/AIDS, Plagues without Germs

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26 Feb 2011
School
Department
Course
Cholera
Until the 19th century
MiasmatistsContagionists
๎€Pettenkofer (1818 โ€“ 1901)
-steadfastly refused to believe in the
germ theory
-drunk a vial of bacteria contaminated
water
๎€Disease caused by โ€˜bad vaporsโ€™
๎€Believed in the โ€˜germ theoryโ€™
announced by Pasteur (1862)
๎€ Koch and Hansen
๎€Diseases spread from person to
person by an infectious agent
Epidemiology
๎€History of cholera is described as the history of pandemics
๎€7 pandemics
1) 1816 โ€“ 1821: originated in India (River Ganges) and was spread by mainly by British
troops, headquarters in Bengal
2) Second pandemic: 1829 โ€“ 1851: more widespread, reaching Europe, Canada, and the
US
-1831 โ€“ mortality of 13% in Cairo, Egypt
-1832 โ€“ 3: 60,000 death in England โ€“ disease known as โ€˜King Choleraโ€™
-In 1849 โ€“ called โ€˜Americaโ€™s greatest scourgeโ€™
3) 1852 โ€“ 1859: Scientific advances in understanding Cholera
4) 1863 โ€“ 1873
5) 1881 โ€“ 1896: hygienic measures stopped its spread to N America
6) 1899 โ€“ 1923: for the most part missed the western hemisphere
7) 1961 - ongoing
๎€Series of epidemics:
-1961: Celebes Islands, Asia, Middle East
-1992: aboard a flight from S America to the US
-1990s: 200,000 in SE Asia
-1994: Zaire, killed 50,000 Rwandan refugees in 21 days
-2000: Africa
Etiology
๎€During the 5th epidemic (1883)
๎€Koch dispatched to Egypt to isolate the microbe
๎€Able to see the bacteria in feces of 12 patients
๎€Vibrio cholerae (due to its vibrating wiggles)
๎€Incubation period โ€“ few hours to 5 days
๎€139 different serogroups
๎€V. cholerae must itself be infected with two viruses:
-One has a gene that codes for the cholera toxin
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-Other must have a gene that codes for the receptor that allows the toxin-coding virus
to enter the bacterium
Infection with Cholera
๎€Trillion V. cholerae excreted each day
โ€ขIndirect transmission: fecal โ€“ oral route of transmission
-Bacteria can survive on food for up to 5 days at ambient temperatures, and up to 10
days at 5-10 C
-Often found in the aquatic environment
โ€ขStomach gastric juice is lethal to V. cholerae
โ€ขLow stomach acidity implies high susceptibility to cholera
โ€ขBacteria may become dormant in between epidemics
Clinical Manifestations
๎€Severe diarrhea
๎€Vomiting
๎€Convulsions
๎€Muscle cramps
๎€Death sometimes within hours
๎€90% of cases are mild or moderate severity
๎€Less than 10% of ill persons develop typical cholera with severe dehydration
Diagnosis and Treatment
๎€Dark-field or phase-contrast microscopy
๎€1800s, a series of treatments
๎€1832 โ€“ rehydration therapy
๎€Food-based ORT
๎€Antibiotics shorten the course of the disease, and reduce the severity of the
symptoms
Underlying Causative Factors
๎€Urbanization
๎€Industrialization
๎€Population growth
๎€Wastewater effluents
๎€Residential crowding
๎€Privies
๎€Closed working environments
๎€Lack of hygiene
Social Disruption
๎€1832 โ€“ high mortality in Liverpool, England
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๎€Prompted โ€˜the cholera riotsโ€™ mainly directed at physicians
๎€Victims went into hiding
๎€Fear of bodies being sold
Outcome
๎€Sanitary maps
๎€Improvements in public health
-Paving roads
-Cleaner streets
-Carrying off wastes
๎€Epidemiologic studies
John Snow (1813 โ€“ 1858)
๎€Father of modern epidemiology
๎€1849 โ€“ traced an outbreak in London to two companies supplying water
๎€1854 โ€“ โ€˜Grand Experimentโ€™ - Investigation of London's Broad Street pump outbreak
๎€Compared water-borne cholera cases in two regions of the city
๎€Discovered that broken pipe contaminated water source and was behind the
London's deadly cholera epidemic of 1854
Cholera carried by WATER
๎€When the pump was inactivated, the epidemic ceased
๎€Cholera was a disease carried by water and not air
๎€Supported by the work of Louis Pasteur and Koch on the โ€˜germ theoryโ€™ 35 years later
Prevention
๎€Sterilization
๎€Sewage
๎€Sources
๎€Water purification
๎€Sensitive surveillance and prompt reporting
SUMMARY
Important contribution learned from the cholera pandemics:
I. Etiology of the disease
II. Concepts of contagion
III. Development of sanitation procedures and techniques
IV.Development of public health policies and institutions
V.Developments in scientific field of study โ€“ epidemiology, medical geography
VI. Development in therapy
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Document Summary

pettenkofer (1818 1901) steadfastly refused to believe in the germ theory drunk a vial of bacteria contaminated water. believed in the germ theory" announced by pasteur (1862) diseases spread from person to person by an infectious agent. history of cholera is described as the history of pandemics. 7 pandemics: 1816 1821: originated in india (river ganges) and was spread by mainly by british troops, headquarters in bengal, second pandemic: 1829 1851: more widespread, reaching europe, canada, and the. 1831 mortality of 13% in cairo, egypt. 1832 3: 60,000 death in england disease known as king cholera". 1992: aboard a flight from s america to the us. 1994: zaire, killed 50,000 rwandan refugees in 21 days. koch dispatched to egypt to isolate the microbe. able to see the bacteria in feces of 12 patients. vibrio cholerae (due to its vibrating wiggles) incubation period few hours to 5 days.

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