提供: Vaccipedia | Resources for Vaccines, Tropical medicine and Travel medicine
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Overview of Tropical Medicine
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Definition of the tropics
- Between the Tropic of Cancer (north latitude 23°26′) and the Tropic of Capricorn (south latitude 23°26′)
- Covers 40% of land surfaces and 40% of population
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Top 3 causes of death in LMICs, HICs and worldwide in 2016
*Bold names are communicable diseases
| Worldwide |
LMICs |
HICs |
- Ischemic heart disease
- Stroke
- Chronic obstructive pulmonary disease (COPD)
|
- Lower respiratory infections
- Diarrhea
- Ischemic heart disease
|
- Ischemic heart disease
- Stroke
- Alzheimer and other dementias
|
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Changes of top 10 causes of death worldwide from 2010 to 2016
- Tuberculosis ranked down to the 10th in 2016 from the 6th in 2010
- HIV/AIDS ranked down out of 10 in 2016 from the 7th in 2010
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List Neglected Tropical Diseases (NTDs) and what are not listed as NTDs
| Virus |
- Dengue & Chikungunya (dengue virus, chikungunya virus)
- Rabies (rabies virus)
|
| Bacteria |
- Buruli ulcer (Mycobacterium ulcerans)
- Leprosy (Mycobacterium leprosy)
- Trachoma (Chlamydia trachomatis)
- Yaws (Treponema pallidum pertenue)
|
| Protozoa |
- Chagas disease, American trypanosomiasis (Trypanosoma cruzi)
- Human African trypanosomyasis, Sleeping sickness (Trypanosoma brucei spp.)
- Leishmaniasis (cutaneous and visceral) (Leishmania spp.)
|
| Parasites - Nematodes |
- Dracunculiasis, Guinea worm (Dracunculus medinensis)
- Lymphatic filariasis (Wuchereria bancrofti, Brugia malayi)
- Onchocerciasis (Onchocerca volvulus)
- Soil-transmitted helminth infections
|
| Parasites - Trematodes |
- Foodborne trematode infections
- Schistosomiasis (Schistosoma spp.)
|
Parasites -
Cestodes |
- Echinococcosis (Echinococcus granulosus, E. multilocularis)
- Taeniasis/Cysticercosis (Taenia spp.)
|
| Ectoarasites |
- Scabies, Tungiasis & other ectoparasites (mite, sandflea, etc.)
|
| Fungi |
- Mycetoma, Chromoblastomycosis (chromomycosis) & other deep mycoses (various spp.)
|
| Non-communicable |
- Snakebites
|
- These are NOT listed as NTDs
- HIV/AIDS
- Tuberculosis
- Malaria
- Lower respiratory infections
- Diarrhea
Virus
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Two major classification manners of viruses
- RNA virus vs DNA virus
- Enveloped virus vs Non-enveloped virus
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Diagnostic methods of virus infection
- Detection of pathogen
- Genome detection by PCR and other NAATs (nucleic acid amplification tests)
- Antigen detection by ELISA and immunochromatography, etc.
- Virus isolation using human/animal cells
- Detection of antibody
- IgM or IgG by ELISA and immunochromatography, etc.
- Neutralizing antibody using human/animal cells
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Definition of arboviruses
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Classification of major arboviruses and their major vectors
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Warning signs of severe dengue
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List of Vaccine-preventable arbovirus infections
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Essential knowledge of HIV
Bacteria
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Biological basis of Gram staining
- Bacteria have both of cell wall and cell membrane
- Human and other animal cells have no cell wall
- Plant cells have cell wall
- Some bacteria have thick cell wall without outer membrane
- Other bacteria have thin cell wall with outer membrane
- Cell wall contains a layer of Peptidoglycan
- Thick peptidoglycan layer catches and keep crystal violet with iodine
- Outer membrane catches crystal violet with iodine but easily lose them by ethanol rinsing
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Classification of major Gram-Positive cocci
Catalase Positive
in tubes |
Coagulase Positive
in tubes |
Coagulase Negative
in tubes |
|
|
- Staphylococcus epidermidis
- Staphylococcus saprophyticus
|
Catalase Negative
in tubes |
α hemolytic
(partial hemolysis)
on media |
β hemolytic
(complete hemolysis)
on media |
γ hemolytic
(no hemolysis)
on media |
- Streptococcus pneumoniae
- Streptococcus suis
- viridans Streptococcus
|
- Group A (beta) streptococci (Streptococcus pyogenes)
- Group B (beta) streptococci (Streptococcus agalactae)
- Group C (beta) streptococci
- Group G (beta) streptococci
|
- Streptococcus bovis
- Enterococcus faecium
- Enterococcus faecalis
|
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Classification of major Gram-Positive bacilli
|
Spore forming |
Non-spore forming |
| Aerobic |
- Bacillus anthracis
- Bacillus cereus
|
- Corynebacterium diphtheria
|
| Anaerobic |
- Clostridium tetani
- Clostridium perfringens
|
|
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Classification of major Gram-Negative cocci
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Classification of major Gram-Negative bacili
| Lactose fermenting |
- Escherichia coli
- Klebsiella pneumoniae
|
| Non-lactose fermenting |
- Shigella spp.
- Salmonella spp.
- Yersinia pestis
|
| Non-fermenting |
- Pseudomonas aeruginosa
- Burkholderia pseudomallei
|
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Essential knowledge of Tuberculosis
- Bacterial structure different from other major bacteria
- Too thick lipid-rich cell wall; acid fast
- Epidemiology and disease burden
- Three species causing clinical tuberculosis
- Mycobacterium tuberculosis
- M. bovis
- M. africanum (only in Africa)
- Airborne transmission
- No contact/fomite transmission
- Contaminated milk ingestion may cause food-borne tuberculosis by M. bovis (bovis means cow)
- Three major Symptoms
- Cough for weeks
- Weight loss for weeks
- Night sweats for weeks
- Diagnostic methods
- sputum microscopy (Ziel-Nielsen staining)
- genome detection by GeneXpert (also detects resistance)
- culture (6-8 weeks)
- chest X-ray
- urine LAM assay
- Mantoux test and IGRA for latent infection
- Potential of long-term (months, years to decades) infection
- Human immune system cannot eliminate established infection but only contains (just to 'hide' Mycobacterium)
- HIV-Tb co-infection is soooooo major public health problem
- Treatment
- 6 months (2 intensive + 4 maintenance)
- Definition of drug resistance
Protozoa
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How protozoa differ from bacteria
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Classification of major protozoa in terms of reproduction manners and infecting organs/cells
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Essential knowledge of malaria
- Epidemiology and disease burden of malaria worldwide
- Especially of Plasmodium falciparum
- Essential lifecycle
- Mosquito stage
- Human liver stage
- Human red cell stage
- Only P. vivax and P. ovale have hypnotic stage in liver cause relapse
- All species cause recrudescence due to inadequate/improper treatment
- Fever, Anemia, Splenomegaly
- Cerebral malaria almost only by P. falciparum, which leads to high mortality
- Diagnosis made by Rapid Diagnostic Test (RDT) and Blood smear microscopy (Giemsa staining)
- Blood smear includes thick smear (just to detect Plasmodium) and thin smear (confirm species of Plasmodium and degree of parasitemia as disease severity)
