PERFORMANCE TASK NO.

RESEARCH CAPSULE

In Partial Fulfillment of the Requirements for Earth and Life Science

TOP 20 DEADLIEST DISEASES

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January 2024
 TOP TWENTY DEADLIEST DISEASES AROUND THE WORLD

An organism's structural or functional dysfunction that does not directly arise from physical
harm is referred to as a disease. Disease appears as a direct result of a biological system's molecular and
cellular functioning being disrupted. (Biology of Disease, n.d.) Diseases are also defined in BYJU
(2022) as "a condition that deteriorates the normal functioning of the cells, tissues, and organs.”

There are different classifications of diseases which can be considered in the wide array of list
of diseases. Diseases can also be the Infectious or Non-infectious type. With these various categories
for diseases, most of the lists in the found have different criteria on being ranked as the deadliest their
mortality rating. For this research capsule, the researchers based the top twenty deadliest diseases in the
world by modifying list from Healthline, Digit Insurance, and Livescience websites. Some of the
diseases from each list overlap and the top ranked are prioritized. The researchers decided to be more
specific on some of the diseases listed. For example, the Healthline website by Pietrangelo (2023)
ranked ‘Lower respiratory infection’ for the third place but it includes influenza, pneumonia and
tuberculosis which were mentioned in another article.

This paper presents the causes, symptoms and cure/treatment of the twenty deadliest diseases
in the world. The numbering on this list does not follow a certain criterion on ranking of the danger that
the diseases possess. This compilation followed the referenced lists and applied some modifications in
selecting. Please be advised that there is no direct ranking from this list. This generally functions simply
as a list of top deadliest diseases in no particular order.

1. Coronary Artery Diseases

Based on the article by Pietrangelo (2023), ischemic heart disease or coronary artery diseases
(CAD) are the deadliest disease in the world. It recorded 8.8 million deaths in 2015 and a 15.5% increase
on the number of deaths from the year 2000 to 2015.

It was an unusual cause of death during the start of the 20th century. Though the number of
deaths from CAD declined after reaching a peak in the middle of the 1960s, it remains the biggest cause
of death globally. According to one study, CAD was thought to be responsible for 2.2% of the total
worldwide burden of disease. (Shahjehan, 2023)

CAUSE

Shahjehan (2023) explains that “coronary artery disease is a common heart condition that
involves atherosclerotic plaque formation in the vessel lumen.” “Atherosclerosis is the buildup/plaque
of fats, cholesterol and other substances in and on artery walls.” (Mayo Clinic, 2022) As a result, the
myocardium's (muscular layer of the heart) ability to receive oxygen is compromised by inadequate
blood flow and oxygen. The plaque formation in the coronary arteries’ lumen obstruct blood flow.
Oxygen demand and supply are out of balance as a result from the occlusion of coronary arteries.

There are different factors that causes coronary artery disease. Shahjehan (2023) has
categorized its etiology to nonmodifiable and modifiable factors. “Non-modifiable factors include
gender, age, family history, and genetics. Modifiable risk factors include smoking, obesity, lipid levels,
and psychosocial variables.”

SYMPTOMS

Shahjehan (2023) writes that CAD could manifest as stable ischemic heart disease (SIHD) or
acute coronary syndrome (ACS) which could develop into congestive heart failure (CHF) if it is not
maintained. One of the main symptoms of CAD is chest pain (angina) which should be observed from
the physical activity when it manifested and how the chest pain spread through jaw, neck, left arm, or
into the back. Dyspnea or shortness of breath must also be observed when the patient is either resting
or in activity. Orthopnea or shortness of breath while lying flat could also be another sign of the disease.
Another angle to diagnose the possible presence of CAD is when the patient experiences syncope
(fainting/passing out) or tachypnea (abnormal or rapid breathing). Palpitations with fluid thrill and
heave can also be an indication of CAD. Leg swelling or lower extremity edema is another indication
of possible CAD.

TREATMENT

As stated in Mayo Clinic (2022), coronary artery disease can be treated through holistic and
healthy lifestyle changes of habits that were associated with CAD. Smoking should be cut off from
daily routine while supplementing with balanced diet and proper exercise. However, its treatment could
also be assisted through medication or operation, if needed.

Mayo Clinic (2022) listed the following treatments for CAD in terms of medications:

Cholesterol drugs. Drugs can help lessen the accumulation of plaque in the arteries and lower bad
cholesterol. These medications include fibrates, niacin, bile acid sequestrants, and statins.

Aspirin. Aspirin aids in blood thinning and clot prevention. For certain patients, the primary prevention
of a heart attack or stroke may involve daily low-dose aspirin medication.

Beta blockers. These medications lower heart rate. Additionally, they reduce blood pressure. Beta
blockers may lower your chance of having another heart attack if you've already had one.
Calcium channel blockers. If beta blockers are ineffective for you or you are unable to take them, one
of these medications can be suggested. Calcium channel blockers can aid in reducing chest discomfort
symptoms.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs).

These helps lower blood pressure. They may help keep coronary artery disease from getting worse.

Nitroglycerin. This medicine widens the heart arteries. It can help control or relieve chest pain.
Nitroglycerin is available as a pill, spray or patch.

Ranolazine. This medication may help people with chest pain (angina). It may be prescribed with or
instead of a beta blocker.

2. Stroke

World Health Organization (WHO, 2022) declared stroke as “the leading cause of disability and
second leading cause of death. According to the 2022 version of the Global Stroke Factsheet, the
lifetime risk of having a stroke has climbed by 50% in the past 17 years, with an estimated 1 in 4 people
expected to experience one at some point in their lives. Between 1990 and 2019, there was a rise of
70% in the incidence of stroke, 43% in the number of stroke-related deaths, 102% in the prevalence of
stroke, and 143% in Disability Adjusted Life Years (DALY).

CAUSE

A cerebrovascular accident, sometimes known as a stroke, is an urgent medical condition

distinguished by a sudden disruption of the cerebral vasculature or perfusion. (Khaku, 2023)

It is important to understand that an acute stroke is not an accident, despite the fact that it is
commonly referred to as a cerebrovascular accident. A more appropriate and useful name to characterize
it would be "brain attack," which has a similar connotation to "heart attack." There are two types of
acute stroke: ischemic and hemorrhagic. Ischemic strokes happen when blood vessels get obstructed
which reduces the amount of blood that reaches the brain. Hemorrhagic strokes, on the other hand, are
caused by the rupture of a blood vessel, leading to blood to leak into the intracranial cavity. (Tadi, 2023)

Tadi (2023) mentions that “ischemic stroke is primarily associated with several key risk factors,
including advanced age, hypertension, diabetes, hyperlipidemia, cigarette smoking, arrhythmia, and
cardiac disease.” Physical inactivity, dyslipidemia, food and nutrition, obesity, diabetes mellitus,
cigarette smoking, and atrial fibrillation (AF) are among the modifiable risk factors for stroke that can
be addressed. Hypertension is thought to be the most significant and well-established risk factor.
 Hypertension is the most prevalent cause of ischemic stroke, however in a younger age group,
clotting problems, carotid dissection, and abuse of illicit drugs are the usual causes. (Khaku, 2023)

An inadequate blood supply to a specific region of brain tissue is the first step in the onset of
ischemic stroke. The area of infarction, or center core of damaged tissue, advances toward irreparable
damage in a matter of minutes. On the other hand, the surrounding tissue, labeled as the penumbra, may
not suffer from instantaneous cell death and may recover with prompt reperfusion. (Tadi, 2023)

SYMPTOMS

According to Khaku (2023), the National Institute of Health Stroke Scale (NIHSS) formed evaluation
guidelines in the stroke exam where the patient is examined rapidly through the following items:

• The level of consciousness (alert and responsive, arouses to noxious stimuli, comatose…)
• Language (fluency, naming, comprehension, repetition)
• Dysarthria (slurring) which may be picked up in the history
• Motor (subtle arm weakness can be picked up by performing a pronator drift)
• Visual field deficits
• Eye movement abnormalities (in general if a gaze preference is present, the eyes deviate
towards the side of the lesion)
• Facial paralysis (asking the patient to smile)
• Ataxia (finger to nose)

Mayo Clinic (2023) indicates the following as the symptoms of stroke:

Trouble speaking and understanding what others are saying. A person having a stroke may be
confused, slur words or may not be able to understand speech.

Numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body.
The person can try to raise both arms over the head. If one arm begins to fall, it may be a sign of a
stroke. Also, one side of the mouth may droop when trying to smile.

Problems seeing in one or both eyes. The person may suddenly have blurred or blackened vision in
one or both eyes. Or the person may see double.

Headache. A sudden, severe headache may be a symptom of a stroke. Vomiting, dizziness and a change
in consciousness may occur with the headache.

Trouble walking. Someone having a stroke may stumble or lose balance or coordination.
TREATMENT

The American Stroke Association has suggested the acronym ACT “FAST” to recognize the early
symptoms of a stroke. They include:

• F (Face) - A droop or an uneven smile on a person’s face.

• A (Arms) - Arm numbness or weakness - Elicited by asking the patient to lift the arms
• S (Speech difficulty) - Slurred speech or difficulty in understanding speech
• T (Time) - If any of the above features are present, even if transient, it is time to call the
emergency helpline (911).

The quick restoration of blood flow to the brain is crucial part in the treatment of ischemic stroke.
(Mayo Clinic, 2023) The procedures are the following:

Emergency IV medicine. It is necessary to administer an IV medication that breaks up clots within 4.5
hours of the onset of symptoms. It is best to provide the medication as soon as possible. Receiving
treatment quickly may lessen problems and increase your chances of survival. By breaking up the blood
clot that was causing the stroke, this medication opens up blood flow again. People may recover from
strokes more fully if the stroke's cause is promptly eliminated.

Emergency endovascular procedures. Medical practitioners may choose to treat ischemic strokes
directly within the clogged blood vessel. After an ischemic stroke, endovascular therapy has been
demonstrated to enhance results and lessen long-term disability. It can be done through delivering
medicines directly through the brain or removing the clot with a stent retriever.

There are also other procedures that can be recommended through opening up the blocked artery:

Carotid endarterectomy. The blood vessels which supply blood to the brain on either side of the neck
are called carotid arteries. By removing the plaque obstructing a carotid artery, this procedure may lower
the risk of an ischemic stroke. There are dangers associated with a carotid endarterectomy as well,
particularly for those who have heart disease or other illnesses.

Angioplasty and stents. Via an artery in the groin, a surgeon inserts a catheter into the carotid arteries.
After that, the constricted artery is widened by inflating a balloon. To hold onto the opening artery, a
stent can then be inserted.

Blood-thinning medicines can also be administered to prevent blood clots but accompanied with
treatment like other medicines or blood products transfusion, to counteract its effects. Additionally,
medications can lower blood pressure, prevent blood vessel spasms, lessen brain pressure, and prevent
seizures. Meanwhile, some surgery procedures for stroke caused by aneurysm, arteriovenous
malformation (AVM) or other blood vessel condition: surgical clipping, coiling or endovascular
embolization, Surgical removal of a tangle of thin-walled blood vessels (AVM), and stereotactic
radiosurgery. (Mayo Clinic, 2023)

Stroke recovery and rehabilitation is an important part of the treatment post stroke. Close
monitoring is important specially at the first 24 hours. Rehabilitation programs are recommended
depending on the status of the patient.

Tadi (2023) explains that it is possible to prevent and treat acute stroke. By increasing awareness
and disseminating information about risk factors and warning indicators, prevention can be achieved.
Reducing the time to diagnosis and treatment has been demonstrated by public education campaigns
directed at a variety of populations. These campaigns emphasize the need of identifying the early
warning signs and symptoms of acute stroke and obtaining prompt emergency care.

There are risk factors for stroke that are modifiable so lifestyle changes can also be used as
treatment. Tadi (2023) states that acute stroke prevention requires changes in diet and exercise, quitting
smoking, and pharmacological treatment for hypertension, dyslipidemia, diabetes mellitus, and at-risk
persons with atrial fibrillation.

3. Influenza

Since Influenza (also known as “flu”) is a contagious respiratory disease, there were a number of
influenza outbreaks in the world that affected millions of people and continuously be affected with
seasonal flu. It is mentioned the Digit Insurance (2024) website, that the first written record of an
influenza epidemic in history was in 1510 but there are possibilities where these outbreaks could have
happened even from 6,000 BC.

There are different types of influenza but most influeza pandemics are from the type of strain that
is transferred from another animal species to humans. Digit Insurance (2024) has listed data from some
of the deadliest influenza outbreaks recorded. The 1510 influenza pandemic has recorded death of 1%
from the infected during that time. The 1889 to 1890 worldwide pandemic recorded 1 million deaths.
However, the biggest number from the chart is from the worldwide influenza pandemic in 1980 – 1920
also known as “Spanish Flu” which killed 17 to 100 million people. The 1957 – 1958 worldwide
influenza pandemic (“Asian Flu”) and Hong Kong flu both recorded 1 to 4 million deaths. The 1977
Russian flu which affected worldwide has 700,000 deaths. The 2009 swine flu pandemic (worldwide)
killed 151,700 – 575,400 people. The 2015 swine flu outbreak in India has recorded 2,035 deaths. Other
than these pandemics or outbreaks, the typical annual seasonal flu kills 290,000 to 650,000 people,
annually.
 Mayo Clinic (2024) states that most people infected with flu can be treated on their own but there
are corresponding complications with influenza which could escalate to a deadly level.

CAUSE

“Influenza is a communicable viral disease that affects the upper respiratory tract, including
upper and lower respiratory passages.” It is commonly called as “flu”. It was caused by a wide spectrum
of influenza viruses. Respiratory droplets are released from their mouth and respiratory system when
someone coughs, talks, or sneezes, make these infections contagious. Contacting inanimate things
contaminated with influenza viruses and then touching the nose or eye can spread the infection.
Influenza is transmissible up to five to seven days after infection and even before the patient exhibits
symptoms. Most healthy people recover totally after infection in a few days, but in some high-risk
groups, consequences like pneumonia and mortality are prevalent. Pregnant women, older people,
immunocompromised individuals, and small toddlers are among these categories. (Boktor, 2023)

Boktor (2023) further explains that there are four types of influenza, namely, A, B, C, and D.
Every year, during the epidemic season, influenza types A and B infect humans. Based on the
combination of hemagglutinin (H) and neuraminidase (N) proteins produced on the virus surface,
influenza A can be classified into many subtypes. There are two lineages of influenza B viruses that
have been active in recent influenza seasons: influenza B Yamagata and influenza B Victoria. The
species-specificity of influenza viruses is attributed to its receptors.

Human infections can result from animal influenza viruses if the virus's antigenic properties
alter. Transmission from person to person is typically inefficient when this occurs. If the spread of
influenza from person to person becomes effective, pandemics similar to those that occurred in 1918
and 2009 may occur. These viruses are concerning because they have the potential to evolve and become
contagious, which could lead to a serious pandemic. (Boktor, 2023)

SYMPTOMS

Influenza is an acute medical condition that mostly affects the upper respiratory system,
resulting in inflammation of the trachea and upper respiratory tree. Most healthy persons experience
self-limiting disease, and the acute symptoms last for seven to 10 days. The viral syndrome,
characterized by high fever, coryza, and body aches, is brought on by the immune system's response to
the viral infection and the interferon response. Severe consequences include primary viral pneumonia,
subsequent bacterial pneumonia, hemorrhagic bronchitis, and even death is more common in high-risk
groups with chronic lung disorders, heart disease, and pregnancy. In as little as 48 hours from the onset
of symptoms, these serious consequences may manifest. During the 48-hour mark, on average, the virus
peaks in the upper and lower respiratory tracts where it begins to multiply following the inoculation.
(Boktor, 2023)

According to Boktor (2023), depending on factors like age, comorbidities, vaccination history,
and innate immunity to the virus, the clinical manifestation of influenza can vary from mild to severe.
Patients who have had the seasonal vaccination often have less symptoms and a lower risk of
complications. In mild cases, runny nose, congested eyes, fever, sore throat, myalgia, headache, and
cough are signs and symptoms of influenza. A common presentation of certain ocular symptoms, such
as photophobia and pain with varying characteristics, is a frontal or retro-orbital headache. The viral
tropism connected to specific kinds and subtypes is the source of ocular (eye) pain. Within 48 hours of
the onset of severe cases, patients may experience dyspnea, tachycardia, hypotension, and require
supportive breathing measures.

TREATMENT

In most healthy people without underlying comorbidities, influenza infection is self-limited and
mild. For healthy people with minor infections, antiviral therapy is not required. (Boktor, 2023)

Mayo Clinic (2004) advices to treat the flu or ease symptoms through getting adequate rest and
plenty of fluids. Pain relievers can also be considered to relieve the fever, headache, and achiness
experienced with influenza.

Healthcare professionals may recommend an antiviral medication to treat the flu if you have a
serious infection or are more likely to experience complications. Both baloxavir and oseltamivir are
administered orally. An apparatus resembling an asthma inhaler is used to inhale zanamivir. Anyone
with lung illness or asthma or other chronic respiratory conditions shouldn't use zanamivir. On the other
hand, Peramivir, an intravenous drug, may be prescribed to hospitalized patients. These medications
can help avoid major problems and shorten your illness by one or two days. (Mayo Clinic, 2024)

4. Pneumonia

As mentioned by Sattar (2023), since the word "pneumonia" comes from the ancient Greek word
"pneumon," which meaning "lung," it also denotes "lung disease." Dadonaite (2023) writes that this
disease has killed 2.5 million people in 2019. Dadonaite (2023) also headlines that “pneumonia is the
leading cause of death for children younger than 5 years old” where 15% of all child deaths in 2017 is
caused by pneumonia.
CAUSE

In terms of medicine, pneumonia is an inflammation of the parenchyma of one or both lungs,

usually but not always caused on by infections. It can arise from a variety of sources, such as fungus,
viruses, bacteria, and parasites. The primary cause of morbidity and mortality is bacterial pneumonia.

Sattar (2023) mentions that the common classification of bacteria was into "typical" and
"atypical" organisms, depending on their etiology. Typical organisms can be observed on Gram stain or
cultivated on conventional media. “Typical pneumonia refers to pneumonia caused by Streptococcus
pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Group A streptococci, Moraxella
catarrhalis, anaerobes, and aerobic gram-negative bacteria.” "Atypical" organisms don't possess these
characteristics. “Atypical pneumonia is mostly caused by Legionella, Mycoplasma pneumoniae,
Chlamydia pneumoniae, and Chlamydia psittaci.”

There are four categories in the new classification of bacterial pneumonia: (Sattar, 2023)

Types of Bacterial Pneumonia

• Community-acquired Pneumonia (CAP): The acute infection of lung tissue in a

patient who has acquired it from the community or within 48 hours of the hospital
admission. The most common cause of community-acquired pneumonia (CAP) is
S. pneumoniae, followed by Klebsiella pneumoniae, Haemophilus influenzae, and
Pseudomonas aeruginosa.
• Hospital-acquired Pneumonia (HAP): The acute infection of lung tissue in a non-
intubated patient that develops after 48 hours of hospitalization. The most common
causes of … HAP are MRSA (methicillin-resistant Staphylococcus aureus) and
Pseudomonas aeruginosa.
• Ventilator-associated Pneumonia (VAP): A type of nosocomial infection of lung
tissue that usually develops 48 hours or longer after intubation for mechanical
ventilation. The causative agents of VAP include both multi-drug resistant (MDR)
agents (e.g., S. pneumoniae, other Strep spp, H. influenzae, and MSSA) and non-
MDR (e.g., P. aeruginosa, methicillin-resistant Staphylococcus aureus,
Acinetobacter spp. and antibiotic-resistant Enterobacteriaceae) bacterial
pathogens.
• Healthcare-associated (HCAP): The acute infection of lung tissue acquired from
healthcare facilities such as nursing homes, dialysis centers, outpatient clinics, or
a patient with a history of hospitalization within the past three months. The most
common causes of HCAP … are MRSA (methicillin-resistant Staphylococcus
aureus) and Pseudomonas aeruginosa.
 Sattar (2023) adds that the lower respiratory tract is constantly exposed to environmental
pathogens and is not sterile. Bacterial pneumonia is caused by the aforementioned bacteria invading
and spreading within the lung parenchyma at the alveolar level. Pneumonia's clinical state results from
the body's inflammatory reaction to it. Many host defenses, including mechanical ones (such as hair in
the nostrils and mucus on the nasopharynx and oropharynx) and chemical ones (such as proteins made
by alveolar epithelial cells like surfactant protein A and D, which have the intrinsic property of
opsonizing bacteria), cooperate in the lungs to prevent the proliferation of microorganisms. Immune
cells like alveolar macrophages, which aim to engulf and destroy bacteria that are multiplying,
constitute another part of the pulmonary defense system. However, once bacteria surpass the capacity
of host defenses, they start to proliferate. In this circumstance, the alveolar macrophages start the
inflammatory response to boost the lower respiratory tract defenses. The primary cause of bacterial
pneumonia's clinical presentation is this inflammatory reaction.

There are different possible exposures for the patient, aspiration risks, host variables, and
symptoms upon presentation. Sattar (20023) further explains “some associations of exposure and
etiologies of bacterial pneumonia.”:

• Contaminated air-conditioning and water systems may cause Legionella

pneumonia.

• Crowded places, such as jails, shelters, etc., expose a person to Streptococcus

pneumonia, Mycobacteria, Mycoplasma, and Chlamydia.

• Exposures to several animals, such as cats, sheep, and cattle, may lead to infection
with Coxiella burnetii

• Some birds, such as chickens, turkeys, and ducks, can expose a person
to Chlamydia psittaci.

Pneumonia secondary to aspiration is more common in patients at higher risk of aspiration.

Some of the risks of aspirations are: “altered mentation, drug abuse, dysphagia, Gastroesophageal
reflux disease (GERD), alcoholism, and seizure disorder”. (Sattar, 2023)

Sattar (2023) explains the host mechanisms associated with the manifestation of bacterial
pneumonia. Examining a thorough medical history is crucial in order to identify potential causes of
pneumonia. Asthma, COPD, smoking, and immunocompromised state, for example, can all be risk
factors for H. influenzae infection. The winter months are when H influenza most frequently manifests.
In a similar vein, family history, medication, social, and sexual factors can all be helpful in figuring out
the origin of a disease.
SYMPTOMS

According to Mayo Clinic (2020), pneumonia can present with mild to severe signs and
symptoms, contingent on the type of germ that caused the illness, your age, and general health. Though
they endure longer, mild symptoms and indicators are frequently confused with those of the flu or cold.
Pneumonia symptoms and indicators could be the following:

• Chest pain when you breathe or cough

• Confusion or changes in mental awareness (in adults age 65 and older)
• Cough, which may produce phlegm
• Fatigue
• Fever, sweating and shaking chills
• Lower than normal body temperature (in adults older than age 65 and people with
weak immune systems)
• Nausea, vomiting or diarrhea
• Shortness of breath

TREATMENT

Grief (2018) explains that pneumonia is a common respiratory infection and warrants careful
consideration of antibiotic initiation and choice, along with knowledge of local antibiotic resistance
patterns.

Mayo Clinic (2020) explains that both the infection must be cured and complications must be
avoided as part of pneumonia treatment. Most cases of community-acquired pneumonia can be treated
with medicine at home. The majority of symptoms go away in a few days or weeks, but fatigue might
linger for up to a month. The type and severity of your pneumonia, your age, and your general health
will all affect the particular treatments you undergo. Among the choices are:

Antibiotics. These are given as medicines used to treat pneumonia. Although the identification of the
bacteria that caused the pneumonia is important in treating it, it might take time. The doctor might
suggest switching to a different antibiotic if your symptoms are observed not to have any improvements.

Cough medicine. There are recommended medicines to target calming cough so that the patient could
rest. Avoiding total cessation of coughing is a good idea since coughing helps clear fluid out of the
lungs.

Fever reducers/pain relievers. These are given for the fever and discomfort of the patient. These
consist of drugs like aspirin, acetaminophen (Tylenol, etc.), and ibuprofen (Advil, Motrin IB, etc.).
 Sattar (2023) expands the therapy for bacterial pneumonia. If the patient is identified for
outpatient treatment, patients with comorbid illnesses (diabetes, cancer, etc.) is fluoroquinolone or beta-
lactams plus macrolide. Doxycycline or macrolide can be administered empirically in patients without
comorbid conditions. Since the empirical regimen is virtually always successful, testing is typically not
done. On the other hand, non-ICU inpatient setting is recommended with fluoroquinolone or macrolide
+ beta-lactam. Inpatient setting in ICU is given eta-lactam + macrolide or beta-lactam +
fluoroquinolone.

Additionally beneficial to the patient are counseling, vaccination against pneumococcal disease,
and quitting smoking. Other measures for the treatment of pneumonia are: (a) hydration, (b) chest
physical therapy, (c) monitoring with pulse oximetry, (d) upright positioning, (e) respiratory therapy
with bronchodilators, (f) mechanical support if patients are in respiratory distress, (g) nutrition, and (h)
early mobilization.

5. Tuberculosis

Evidence of TB has been reported in human remains dated thousands of years (Hershkovitz et
al., 2017, K Zaman, 2010). Based on the article by Pietrangelo (2023), tuberculosis (TB) recorded 1.3
million deaths in 2015 and caused 2.4% of deaths worldwide.

Global efforts to eradicate tuberculosis have been concentrated in the last few decades. Positive
results had been obtained from these efforts, particularly after 2000, when the World Health
Organization (WHO, 2017) estimated that the annual global incidence rate of tuberculosis had
decreased by 1.5%. In addition, the death rate from tuberculosis has decreased dramatically and
consistently. Global tuberculosis death decreased by 22% between 2000 and 2015, according to data
from the World Health Organization (WHO, 2016).

Even with the progress made in controlling the disease and the reduction in the number of new
cases and deaths, tuberculosis (TB) continues to be a major cause of morbidity and mortality globally.
Developing nations bear the lion's share of the worldwide burden of tuberculosis deaths and new
infections particularly among those with weakened immune systems; in 2015, 60% of tuberculosis
deaths occurred in six countries: South Africa, Nigeria, China, India, Indonesia, and Pakistan (WHO,
2017). Children are particularly susceptible; in 2015, the World Health Organization reported that
tuberculosis caused one million pediatric infections. (Adigun, 2023) Pietrangelo (2023) reveals that TB
ranks among the leading causes of death for HIV-positive individuals. Moreover, active tuberculosis is
eighteen times more common in those with HIV.
CAUSE

As stated by Adigun (2023), Mycobacterium tuberculosis, the causative agent of tuberculosis

(TB), is a long-standing human illness that primarily affects the lungs. Thus, pulmonary disease is the
most typical way that tuberculosis manifests itself. “However, TB is a multi-systemic disease with a
protean presentation.” The most frequently impacted organ systems include the skin, the central
neurological system, the musculoskeletal system, the reproductive system, the liver, the gastrointestinal
(GI), the respiratory, and the lymphoreticular systems.

“M. tuberculosis is an alcohol and acid-fast bacillus. It is part of a group of organisms classified
as the M. tuberculosis complex. M. tuberculosis is a non-spore-forming, non-motile, obligate-aerobic,
facultative, catalase-negative, intracellular bacteria.” (Adigun, 2023)

“The principal mode of spread [of Tuberculosis] is through the inhalation of infected
aerosolized droplets.” Whether an individual's exposure to the organism is primary or secondary, genetic
variables influence the body's capacity to successfully limit or eradicate the infectious inoculum.
Furthermore, M. tuberculosis has a number of virulence characteristics that hinder alveolar
macrophages from getting rid of the organism from an infected person. (Adigun, 2023)

Adigun (2023) further explains that the M. tuberculosis organism has various unique properties
compared to other bacteria, such as the presence of several lipids in the cell wall, including mycolic
acid, cord factor, and Wax-D. The following characteristics of the Mycobacterium TB infection are
believed to be influenced by the high lipid content of the cell wall:

• Resistance to several antibiotics

• Difficulty staining with Gram stain and several other stains
• Ability to survive under extreme conditions such as extreme acidity or alkalinity, low
oxygen situation, and intracellular survival (within the macrophage)

Primary tuberculosis symptoms result from the Mycobacterium organism's initial contact with
a host. The Ghon focus of primary TB refers to the area of the lungs where the disease is typically
confined. In the majority of afflicted patients, the Ghon focus experiences latency. We refer to this
condition as latent tuberculosis. Latent TB is capable of being reactivated after immunosuppression in
the host. A few percentages of individuals would get an active illness after their initial encounter.
Primary progressive tuberculosis is the term used to describe such cases. People with
immunosuppression, malnourished individuals, children, and those using steroids for an extended
period of time are susceptible to primary progressive tuberculosis. (Adigun, 2023)

Adigun (2023) also adds that some of tuberculosis cases are secondary tuberculosis, which
occurs after a protracted latency period (many years after the original primary infection). Reactivation
of a latent tuberculosis infection is typically the cause of secondary tuberculosis. The lesions of
secondary tuberculosis are in the lung apices. Re-infection, or contracting the disease after being
infected a second time, accounts for a smaller percentage of cases of secondary tuberculosis.

There is additional evidence linking the use of immunosuppressive medications, such as long-
term corticosteroid therapy, to a higher risk of tuberculosis. More recently, there has been evidence
linking the use of a monoclonal antibody that targets tumor necrotic factor alpha (TNF-alpha), an
inflammatory cytokine, to an elevated risk. Other major risk factors of tuberculosis are: (a)
socioeconomic factors such as poverty, malnutrition and wars; (b) immunosuppression; and (c)
occupational risk of mining, construction workers, and pneumoconiosis (silicosis). (Adigun, 2023)

SYMPTOMS

Some of the most typical physical symptoms of pulmonary tuberculosis are chronic cough,
hemoptysis, weight loss, low-grade fever, and night sweats. (Adigun, 2023)

According to Mayo Clinic (2023), tuberculosis (TB) infection occurs when the bacteria from
the disease survive and grow in the lungs. There are three stages to a tuberculosis infection. Every stage
has a particular set of symptoms.

Primary TB infection. The initial phase is referred to as the primary infection. Immune system cells
locate and seize the pathogens. The germs might be entirely destroyed by the immune system. However,
some trapped bacteria might continue to survive and proliferate. A primary infection usually causes no
symptoms at all for most people. Some individuals may experience flu-like symptoms, like: low fever,
tiredness, and cough.

Latent TB infection. Latent tuberculosis infection typically follows primary infection. TB-infected
lung tissue is surrounded by a wall formed by immune system cells. If the immune system manages to
contain the bacteria, they will be unable to cause any more damage. The germs, however, endure. When
a TB infection is latent, there are no symptoms.

Active TB disease. When an infection gets out of control by the immune system, active tuberculosis
disease develops. Infections in the lungs or other bodily regions are brought on by germs. Active
tuberculosis infection may follow a primary infection. However, latent tuberculosis infection for months
or years generally precedes it. Active tuberculosis symptoms in the lungs typically start out mildly and
get worse over a few weeks. They could consist of:

• Cough.
• Coughing up blood or mucus.
• Chest pain.
• Pain with breathing or coughing.
 • Fever
• Chills.
• Night sweats.
• Weight loss.
• Not wanting to eat.
• Tiredness.
• Not feeling well in general.

Active TB disease outside the lungs. Extrapulmonary tuberculosis happens when the other parts of the
body get infected with tuberculosis (TB) after it leaves the lungs. The body part that is infected affects
the symptoms that are experienced. Typical symptoms could be:

• Fever. • Not wanting to eat.

• Chills. • Tiredness.
• Night sweats. • Not feeling well in general.
• Weight loss. • Pain near the site of infection

TREATMENT

Adigun (2023) lists down the treatment methods for latent tuberculosis and active tuberculosis.

The NTCA and CDC-recommended treatment regimens, which consist of two alternate
monotherapy regimens with daily isoniazid and three preferred rifamycin-based regimens, are included
in the 2020 latent tuberculosis infection (LTBI) treatment guidelines. These are only advised for people
who have Mycobacterium tuberculosis infection and are thought to be susceptible to rifampin or
isoniazid. For adults and children over the age of two, the suggested preferred regimen is rifapentine
with isoniazid once weekly for three months. For HIV-negative adults and children of all ages, an
additional alternative is to take rifampin daily for four months. The ideal course of treatment,
conditionally suggested for adults, children, and HIV patients alike, consists of three months of daily
isoniazid + rifampin. Other suggested regimens include taking isoniazid daily for 6 or 9 months.

A combination of medications is needed to treat confirmed tuberculosis. For tuberculosis,

combination therapy is always recommended; monotherapy should never be utilized. The following
anti-TB drug regimen is the most widely used one for tuberculosis:

• First-Line of Medications, Group 1: Isoniazid, Rifampicin, Rifabutin, Rifapentine,

Pyrazinamide, Ethambutol
• Second-Line Anti-tuberculosis Drugs, Group 2: Injectable aminoglycosides (Amikacin,
Kanamycin, Streptomycin) and Injectable polypeptides (Capreomycin, Viomycin)
 • Second-Line Anti-tuberculosis Drugs, Group 3: Oral and injectable fluoroquinolones
(Levofloxacin, Moxifloxacin, Ofloxacin, Gatifloxacin)
• Second-Line Anti-tuberculosis Drugs, Group 4: Para-aminosalicylic acid, Cycloserine,
Terizidone, Ethionamide, Prothionamide, Thioacetazone, Linezolid
• Third-Line Anti-tuberculosis Drugs, Group 5: Clofazimine, Linezolid, Amoxicillin/
clavulanic acid, Imipenem/cilastatin, Clarithromycin

It is advised to begin anti-tuberculous therapy right away for patients with active TB and HIV
who have significant immunosuppression. Two to four weeks later, antiretroviral therapy should be
started. Immune reconstitution inflammatory syndrome (IRIS) cannot develop if antiretroviral
medication treatment is postponed. This condition is defined by the paradoxical worsening of primary
illness symptoms upon starting antiretroviral medication treatment. Retroviral therapy should begin no
earlier than two weeks after the initial treatment of the presenting infection. The chance of IRIS
increases with the early initiation of antiretroviral therapy. Antiretroviral therapy should not be delayed
needlessly as this increases the chance of dying from AIDS.

6. Lung Cancers

Pietrangelo (2023) lists down trachea, bronchus and lung cancers in the top 10 deadliest diseases
in the world. Statistics has shown that 1.7 million deaths in 2015 are respiratory cancers with sharing
3% of the deaths worldwide. For this paper, the researchers narrowed down on lung cancer in discussing
the causes, symptoms and treatments. The researchers see the lungs as the main component of
respiratory system.

Siddiqui (2023) notes that at 12.4% of all cancers diagnosed globally, lung cancer is the most
prevalent disease to be diagnosed and the primary cause of cancer-related mortality. Historically, it
appears that only the developed countries are affected by the lung cancer epidemic. According to recent
data, the incidence of lung cancer appears to be sharply increasing, with 49.9% of newly diagnosed
cases occurring in developing nations. It's fascinating to remember that during the start of the 20th
century, lung cancer was a comparatively uncommon illness. Its significant increase in subsequent
decades can largely be attributed to the rise in both male and female smoking rates.

CAUSE

“Lung cancer or bronchogenic carcinoma refers to tumors originating in the lung parenchyma
or within the bronchi.” Lung cancer is most frequently caused by smoking. It is estimated that smoking
is the cause of 90% of cases of lung cancer. Men who smoke are most at risk. Exposure to other
carcinogens, like asbestos, increases the risk considerably. Passive smoking increases the risk of lung
cancer by 20 to 30 %. Radiation therapy for conditions other than lung cancer, such as non-Hodgkins
lymphoma and breast cancer, is an additional cause of concern. Lung cancer is also linked to exposure
to metals like arsenic, nickel, chromium, and polycyclic aromatic hydrocarbons. Lung conditions other
than smoking, such as idiopathic pulmonary fibrosis, raise the risk of lung cancer. (Siddiqui, 2023)

Siddiqui (2023) notes that the two other known risk factors for lung cancer are asbestos and
radon. Exposure to asbestos, especially in the workplace, raises the risk of lung cancer in a dose-
dependent way that varies depending on the kind of asbestos fiber. There exists a slight but noteworthy
correlation between radon exposure and lung cancer risk among uranium workers. It has also been
demonstrated that radon builds up in homes as a byproduct of uranium and radium decay.

“The pathophysiology of lung cancer is very complex and incompletely understood.” Lung
epithelial dysplasia is thought to be caused by recurrent exposure to carcinogens, such as cigarette
smoke. Continued exposure alters protein synthesis and causes genetic mutations. Carcinogenesis is
then encouraged and the cell cycle is upset as a result. (Siddiqui, 2023)

SYMPTOMS

Siddiqui (2023) reveals that lung cancer does not have any particular symptoms or indicators.
When most patients first arrive, their condition has already progressed. The local effects of the tumor
cause symptoms of lung cancer, such as kidney stones from persistent hypercalcemia, stroke-like
symptoms related to brain metastases, cough from bronchial compression by the tumor, and
paraneoplastic syndrome.

Siddiqui (2023) adds that between 50 and 75 percent of lung cancer patients have a cough.
Mucinous adenocarcinoma is characterized by a cough that produces copious amounts of thin, mucoid
fluids. Fifteen to thirty percent of lung cancer patients have hemoptysis. About 20 to 40 percent of lung
cancer patients have chest pain, and up to 25 to 40 percent of cases may have dyspnea at the time of
diagnosis. However, underlying bronchopulmonary disease or lung cancer may be the primary cause of
these symptoms.

Small cell lung cancer frequently presents with superior vena cava syndrome, which includes
dilated neck veins, edema of the face, neck, and upper extremities, and a plethoric look. It might be the
primary presentation of the disease. On the other hand, pancoast syndrome is a symptom of superior
sulcus lung tumors. This manifests as atrophy of the hand muscles, shoulder pain, Horner syndrome,
and indications of bone deterioration. (Siddiqui, 2023)
TREATMENT

A cancer treatment plan is selected by the patient and doctor taking into account various aspects
such the patient's preferences, cancer type and stage, and general health. Patients may decide in some
situations not to get treatment. For example, they might believe that the potential side effects of the
treatment will exceed its advantages. In that scenario, the physician might recommend comfort therapy,
which would solely address the pain or dyspnea (shortness of breath) the malignancy is producing.
(Mayo Clinic, 2022)

Mayo Clinic enumerated the following possible treatment strategy for lung cancer patients:

Surgery. If the cancer is limited to the lungs, surgery can be considered an option for treatment. The
goal of the procedure is for the surgeon to remove both the lung cancer and a margin of healthy tissue.
Wedge resection, segmental resection, lobectomy, and pneumonectomy are among the procedures used
to remove lung cancer.

Radiation therapy. Patients with locally advanced lung cancer may get radiation therapy either before
to or following surgery. It typically comes along with chemotherapy. Combining radiation therapy and
chemotherapy may be the main course of treatment if surgery is not an option. High-powered energy
beams from sources like protons and X-rays are used in radiation therapy to destroy cancer cells.
Radiation therapy involves the patient lying on a table with a machine moving around to target certain
body parts with radiation.

Chemotherapy. Chemotherapy is frequently used to eradicate any cancer cells that may have persisted
following surgery. Radiation therapy can be used in combination with it or alone. Chemotherapy can
also be used to reduce tumors and facilitate their removal prior to surgery. Drugs are used in
chemotherapy to kill cancer cells. Chemotherapy medications can be either orally or administered
intravenously, through a vein in the arm. Typically, a patient receives a mix of medications in a series
of treatments spaced out over weeks or months, with gaps to allow for recovery.

Targeted drug therapy. Treatments with targeted drugs concentrate on particular defects found in
cancer cells. Cancer cells can be killed by specific medication treatments that prevent these
abnormalities.

Immunotherapy. Immunotherapy fights cancer by stimulating the immune system.

Palliative care. Individuals who have lung cancer frequently experience both the adverse effects of
their treatment and the illness's symptoms. Palliative care, or supportive care, is a subspecialty of
medicine that entails collaborating with a physician to reduce symptoms.
 7. Diabetes mellitus

Diabetes mellitus is derived from the Latin term mellitus, which means sweet, and the Greek
word diabetes, which means siphon, to pass through. A historical analysis reveals that Apollonius of
Memphis first used the term "diabetes" in 250–300 BC. The term "Diabetes Mellitus" originated when
ancient Greek, Indian, and Egyptian civilizations realized that the urine produced in this condition
was pleasant. In 1889, Mering and Minkowski made the discovery that the pancreas plays a part in the
pathophysiology of diabetes. At the University of Toronto, Banting, Best, and Collip isolated the
hormone insulin from cow pancreas in 1922, which made an efficient diabetic treatment available that
year. Outstanding research has been conducted over the years, leading to several discoveries and the
development of management techniques to address this expanding issue. Regretfully, diabetes remains
one of the most prevalent chronic illnesses both domestically and globally. (Sapra, 2023)

Diabetes mellitus has recorded 1.6 million deaths in 2015 alone. It encompasses 2.8% of deaths
worldwide. (Pietrangelo, 2023)

Diabetic mellitus (DM) affects 1 in 11 adults worldwide. Type 1 Diabetes mellitus (T1DM)
develops gradually starting at birth and peaks between the ages of 4 and 6 and 10 and 14 years. Of the
children present, about 45% are younger than ten years old. In those under 20, the prevalence is
roughly 2.3 per 1000. Globally, the prevalence of T1DM has been rising. Although Type 2 Diabetes
mellitus (T2DM) often manifests later in life, obesity in teenagers has contributed to a rise in younger
populations. According to estimates from the International Diabetes Federation, 1 in 11 persons aged
20 to 79 worldwide had diabetes in 2015, with 90% of cases being type 2 diabetes. By 2040, experts
estimate that 415 million people worldwide will have diabetes (DM), with the majority of this growth
occurring in populations moving from low to middle-income levels. (Sapra, 2023)

CAUSE

Sapra (2023) discusses that Diabetes mellitus (DM) is a metabolic disorder characterized by
abnormally high blood glucose levels. The main subtypes of diabetes mellitus (DM) are Type 1 diabetes
mellitus (T1DM) and Type 2 diabetes mellitus (T2DM), which traditionally result from defective insulin
secretion (T1DM) and/or action (T2DM). DM has several categories, including type 1, type 2, maturity-
onset diabetes of the young (MODY), gestational diabetes, neonatal diabetes, and secondary causes due
to endocrinopathies, steroid use, etc. While T2DM is expected to affect middle-aged and older adults
who have chronic hyperglycemia as a result of poor dietary and lifestyle choices, T1DM is thought to
manifest in children or teenagers. Since the etiology of type 1 and type 2 diabetes differs significantly,
there are differences in the etiologies, presentations, and therapies of each type of diabetes.
 When diabetes mellitus (DM) occurs, insulin either is unable to function at all or acts
inadequately (insulin resistance), which raises blood sugar levels. The two primary categories of
endocrine cells found in the pancreatic islets of Langerhans are alpha cells, which secrete glucagon, and
beta cells, which produce insulin. Beta and alpha cells are continually adjusting their levels of hormone
releases based on the glucose environment. When glucagon and insulin are out of balance, glucose
levels become unnecessarily unbalanced. (Sapra, 2023)

Sapra (2023) notes that the hallmark of type 1 diabetes is the autoimmune-mediated loss of beta
cells in the pancreas. As a result, beta cells are completely destroyed, which causes either very little or
no insulin to be produced. T2DM has a sneakier beginning in which a functional insulin deficit results
from an imbalance between insulin levels and insulin sensitivity. Although it is multifaceted, age and
fat are the two main causes of insulin resistance.

Genetics and lifestyle play a more intricate role in type 2 diabetes. Compared to T1DM, T2DM
appears to have a stronger genetic profile, according to plenty of evidence. Most individuals suffering
from the condition have at least one parent who has type 2 diabetes. (Sapra, 2023)

Pregnancy-related diabetes is primarily known as gestational diabetes. Its development's cause

is yet unknown. Gestational diabetes is believed to be related to excessive proinsulin, and some research
indicates that proinsulin may cause beta-cell stress. Some people think that high levels of hormones
such estrogen, progesterone, cortisol, prolactin, and human placental lactogen may have an impact on
peripheral insulin sensitivity and beta-cell activity. (Sapra, 2023)

Additionally, Sapra (2023) writes that because the endogenous hormones that are oversecreted
in a number of endocrinopathies have an innate glucogenic action, glucose intolerance and diabetes
mellitus have been linked to acromegaly, Cushing syndrome, glucagonoma, hyperthyroidism,
hyperaldosteronism, and somatostatinomas (tumors in pancreas or gastrointestinal tract).

Excess fatty acids and proinflammatory cytokines cause insulin resistance by impairing glucose
transport and speeding up the breakdown of fat. The body reacts to insufficient insulin responsiveness
or synthesis by mistakenly raising glucagon levels, which exacerbates hyperglycemia. Although insulin
resistance is a part of type 2 diabetes, the disease's full impact occurs when the patient's insulin
production is insufficient to offset their insulin resistance. (Sapra, 2023)

SYMPTOMS

According to Mayo Clinic (2023), the symptoms of diabetes depend on the blood sugar level.
Some of the symptoms of T1DM and T2DM are the following:

• Feeling more thirsty than usual.

 • Urinating often.
• Losing weight without trying.
• Presence of ketones in the urine. Ketones are a byproduct of the breakdown of
muscle and fat that happens when there's not enough available insulin.
• Feeling tired and weak.
• Feeling irritable or having other mood changes.
• Having blurry vision.
• Having slow-healing sores.
• Getting a lot of infections, such as gum, skin and vaginal infections.

TREATMENT

Mayo Clinic (2023) advises that the general treatment for all types of DM are healthy diet and
physical activity. For T1DM, the treatment may include insulin injections or the use of an insulin pump,
regular blood sugar monitoring, and carb counting. A pancreas transplant or an islet cell transplant may
be an option for certain individuals with type 1 diabetes. The mainstay of treatment for type 2 diabetes
is dietary modifications, blood sugar monitoring, and the use of insulin, oral medications, or both. Oral
and other drugs can be given to help the pancreas release more insulin. Pancreas transplant is also an
option specially for patients with T1DM. Bariatic surgery is another option for patients with T2DM that
are obese or have a body mass index higher than 35.

8. Alzheimer’s Disease

Alzheimer’s disease and other dementias are included in Pietrangelo (2023) list of the top ten
deadliest diseases in the world. It is the cause for 2.7% of deaths worldwide and recorded 1.5 million
deaths in 2015.

Alzheimer's is usually an age-related illness. By the year 2050, it is expected that the prevalence
of dementia would have increased four times from its current estimated 24 million cases worldwide.
After 65 years of age, the incidence of Alzheimer's disease doubles every five years. Before 65 years of
age, the age-specific incidence is less than 1% annually; after 85 years of age, it climbs dramatically to
6% annually. beyond the age of 65, prevalence rates rise from 10% to 40% beyond the age of 85.
Alzheimer's disease is slightly more common in women, particularly after the age of 85. (Kumar, 2022)

CAUSE

Dementia is the term used to describe a cognitive deterioration that is severe enough to interfere
with day-to-day activities. In those 65 years of age and above, Alzheimer's disease (AD) accounts for
at least two-thirds of dementia cases. AD is the most prevalent type of dementia. A neurodegenerative
condition known as Alzheimer's disease slowly impairs behavioral and cognitive abilities such as
memory, comprehension, language, attention, reasoning, and judgment. It starts slowly and progresses
over time. (Kumar, 2022)

Alzheimer's disease is a neurological condition that develops gradually and is brought on by

the death of neurons. Usually, it begins in the hippocampal entorhinal cortex. Alzheimer's disease, both
early-onset and late-onset, has been linked to genetics. One risk factor for dementia with early onset is
trisomy 21. Alzheimer's disease has been linked to a number of risk factors. The biggest risk factor for
Alzheimer's disease is getting older. Alzheimer's disease risk factors include traumatic brain injury,
depression, cardiovascular and cerebrovascular illness, smoking, greater paternal age, family history of
dementia, elevated homocysteine levels, and APOE e4 allele status. The risk of Alzheimer's disease
increases by 10% to 30% if you have a first-degree relative who has the condition. (Kumar, 2022)

According to Kumar (2022), the buildup of aberrant neuritic plaques and neurofibrillary tangles
is a hallmark of Alzheimer's disease. Another symptom of Alzheimer's disease is granulovacuolar
degeneration of hippocampus pyramidal cells by amyloid angiopathy. There is a nearly full penetrance
to Alzheimer's disease, making it an autosomal dominant medical condition.

SYMPTOMS

Kumar (2022) reveals that Alzheimer's disease symptoms vary according to the stage of the
disease. Based on the level of cognitive impairment, Alzheimer's disease is categorized as mild,
preclinical or presymptomatic, dementia-stage, and dementia-stage. The DSM-5 classification of
Alzheimer's disease differs from these stages. Episodic short-term memory loss with relative sparing of
long-term memory is the initial and most common presenting symptom; it can be evoked in most
individuals even in the absence of a presenting symptom. Impaired problem-solving, judgment,
executive functioning, motivation, and disorganization follow short-term memory impairment, which
causes issues with multitasking and abstract thought. Executive functioning impairment varies from
mild to severe in the early stages. Language disorders and deficiencies in visuospatial abilities follow.

The mid- to late-stage neuropsychiatric symptoms also included apathy, social withdrawal,
disinhibition, agitation, psychosis, and wandering. Late in the disease, some symptoms that may occur
are dyspraxia or the difficulty executing learned motor tasks, olfactory dysfunction, sleep problems,
and extrapyramidal motor indications such dystonia and akathisia. Subprime reflexes, incontinence,
along with full dependence on caregivers come next. (Kumar, 2022)
TREATMENT

According to Kumar (2022), “there is no cure for Alzheimer's disease, although there are treatments
available that may improve some symptoms.” For the symptomatic treatment of Alzheimer's disease,
two types of medications are authorized:

• Partial N-methyl D-aspartate (NMDA) antagonists – The partial N-Methyl D-aspartate

NMDA antagonist memantine inhibits intracellular calcium buildup by blocking NMDA
receptors.
• Cholinesterase Inhibitors – Acetylcholine is a neurotransmitter that nerve cells use to
communicate with one another and is essential for memory, learning, and cognitive processes.
Cholinesterase inhibitors work by raising acetylcholine levels. Three medications from this
class have FDA approval for the treatment of Alzheimer's disease: galantamine, rivastigmine,
and donepezil.

9. Dehydration due to Diarrheal Diseases

Pietrangelo (2023) notes that diarrheal diseases that causes dehydration has killed 1.4 million
people in 2015 and shares 2.5% of deaths around the world.

According to the World Health Organization (2017), there are around 1.7 billion cases of pediatric
diarrheal illness worldwide annually. Approximately 525,000 children die from diarrheal disease each
year, making it the second most common cause of mortality for children under the age of five. In
majority of cases, the primary causes of diarrheal fatalities were severe dehydration and fluid loss.

Children under five years old are reported to experience three episodes of diarrhea on average
per child per year in developing countries. In some places, there are reports that each year, a child could
experience six to eight episodes. Malnutrition contributes to the development of diarrhea in these
situations. (Nemeth, 2022) The World Health Organization (2017) confirms that a major contributing
factor to malnutrition in children under five is diarrhea.

CAUSE

“Diarrhea is the augmentation of water content in stools because of an imbalance in the normal
functioning of physiologic processes of the small and large intestine responsible for the absorption of
various ions, other substrates, and consequently water.” In other words, “diarrhea is the result of reduced
water absorption by the bowel or increased water secretion.” (Nemeth, 2022)
 The World Health Organization (2017) as known as WHO defines diarrhea as “as the passage
of three or more loose or liquid stools per day (or more frequent passage than is normal for the
individual).”

Depending on the length and nature of the symptoms, diarrhea can be classified as infectious
or non-infectious, acute or chronic. A diarrhea episode that lasts shorter than two weeks is referred to
as acute. The most prevalent cause of acute diarrhea is infection. The majority of cases have a self-
limiting course and are caused by a viral infection. When diarrhea lasts over fourteen days and is
generally not contagious, it is referred to as chronic or persistent diarrhea. Malabsorption, inflammatory
bowel illness, and adverse drug reactions are common causes. (Nemeth, 2022)

Diarrhea is the outcome of either increased water secretion or decreased water absorption by
the colon. The majority of cases of acute diarrhea has an infectious cause. Three types of chronic
diarrhea are generally identified: watery, fatty (malabsorption), or infectious. (Nemeth, 2022)

Lactose intolerance is a kind of watery diarrhea that involves increased water secretion into the
intestinal lumen. Watery diarrhea is caused by the osmotically active lactose, which both attracts and
holds water. (Nemeth, 2022)

Chronic pancreatitis and celiac disease are two common causes of fatty diarrhea. Malabsorption
results from insufficient enzyme release in patients with chronic pancreatitis. (Nemeth, 2022)

The most common causes of diarrhea in its secretory form are viral and bacterial infections. In
this case, damage to the gut epithelium is the cause of the watery stool. Epithelial cells line the digestive
track and assist the absorption of water, electrolytes, and other solutes. Increased intestinal permeability
results from epithelial cell destruction caused by infectious etiologies. Loose stool results from the
injured epithelium cells' inability to absorb water from the intestinal lumen. (Nemeth, 2022)

According to Nemeth (2022), Some causes of diarrhea are also related to daycare centers. In
daycare, some infections proliferate faster. These comprise Shigella, Giardia, Campylobacter,
Cryptosporidium, rotavirus, and astrovirus. The use of daycare centers is growing, which has led to a
rise in rotavirus and Cryptosporidium-related diseases.

Nemeth (2022) writes that gastrointestinal infections can result from various kinds of food. For
example:

• Consumption of raw or contaminated food items is commonly associated with

infectious diarrhea.
• Organisms that are commonly found associated with infectious diarrhea include the
following:
o Dairy products - Campylobacter and Salmonella species
 o Eggs - Salmonella species
o Meats - Clostridium perfringens, Campylobacter, Aeromonas, and Salmonella
species
o Poultry - Campylobacter species
o Ground beef - Enterohemorrhagic E coli
o Seafood - Astrovirus, Aeromonas, Plesiomonas, and Vibrio species
o Pork - C perfringens, Y enterocolitica
o Oysters - Calicivirus, Plesiomonas, and Vibrio species
o Vegetables - Aeromonas species and C perfringens

Meanwhile, Nemeth (2022) reveals that the agents that cause infectious diarrhea in marine
environments are Aeromonas organisms and Shigella species, which are present in swimming pools.
Water chlorination has no effect on Giardia, Cryptosporidium, or Entamoeba, hence polluted water
should raise suspicions about these parasites. Additionally, there is a connection between drinking
water, agriculture, and Campylobacter infection. The significance of travel history lies in its potential
to identify the underlying cause of infectious diarrhea. The most common cause of traveler's diarrhea is
by far enterotoxigenic E coli.

SYMPTOMS

Mayo Clinic (2023) has listed down some of the symptoms that can be observed if the patient
suffers from diarrhea:

• Belly cramps or pain. • Fever.

• Bloating. • Blood in the stool.
• Nausea. • Mucus in the stool.
• Vomiting. • Urgent need to have a bowel movement.

Dehydration is the biggest risk that diarrhea poses. Water and electrolytes (sodium, chloride,
potassium, and bicarbonate) are lost through breathing, sweating, urinating, and watery stools during a
diarrhoeal episode. The absence of replacement for these losses results in dehydration. (WHO, 2017)

There are three degrees of dehydration:

• Severe dehydration (at least two of the following signs):

o lethargy/unconsciousness
o sunken eyes
o unable to drink or drink poorly
o skin pinch goes back very slowly ( ≥2 seconds)
 • Some dehydration (two or more of the following signs):
o restlessness, irritability
o sunken eyes
o drinks eagerly, thirsty
• No dehydration (not enough signs to classify as some or severe dehydration).

TREATMENT

Refueling electrolyte and fluid loss is a crucial part of managing diarrhea. Encourage patients to
consume Gatorade, Pedialyte, or diluted fruit juice. IV fluid rehydration may be required in situations
of diarrhea that are more severe. Stools might become firmer with the use of foods reduced in fiber. A
simple 'BRAT' diet consisting of toast, bananas, oats, white rice, applesauce, soup, and broth is well-
tolerated and has the potential to alleviate symptoms. To lessen the frequency of stools, anti-diarrheal
therapy using anti-secretory or anti-motility medications may be initiated. For patients with more severe
symptoms, oral fluoroquinolone medication combined with empiric antibiotic therapy may be
recommended. Patients with acute diarrhea should be advised to take probiotic supplements as they
have been demonstrated to lessen the intensity and duration of symptoms. The majority of diarrhea
cases can be avoided by practicing proper handwashing and personal hygiene. Hydrating the patients is
also crucial. (Nemeth, 2022)

10. Cirrhosis

1.2 million deaths were recorded in 2015 that are caused by cirrhosis. 2.1% of the deaths
worldwide are associated to cirrhosis. (Pietrangelo, 2023)

CAUSE

According to Sharma (2022), the liver develops fibrosis and nodules as a result of a persistent
damage that changes the liver's typical lobular organization, a condition known as cirrhosis. The liver
can be damaged by a variety of assaults, such as toxins, viral infections, autoimmune diseases, or genetic
disorders. The liver grows scar tissue, or fibrosis, after every insult, yet it retains its ability to function.
The majority of the liver tissue fibroses during a protracted damage, resulting in function loss and the
onset of cirrhosis.

Cirrhosis typically develops from chronic liver disorders. Hepatitis C virus (HCV), alcoholic
liver disease, and nonalcoholic steatohepatitis (NASH) are the most common causes of cirrhosis in the
developed world; in the developing world, the most common causes are hepatitis B virus (HBV) and
HCV. Other causes of cirrhosis include autoimmune hepatitis, primary biliary cholangitis, primary
sclerosing cholangitis, hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency, Budd-Chiari
syndrome, drug-induced liver cirrhosis, and chronic right-sided heart failure. Cirrhosis with an
unknown cause is known as cryptogenic cirrhosis. (Sharma, 2022)

The development of portal hypertension and hyperdynamic circulation is the primary cause of
morbidity and mortality in people with cirrhosis. Portal hypertension arises as a result of intrahepatically
and systemically altered vasoregulatory function and fibrosis, which creates collateral circulation and
hyperdynamic circulation. (Sharma, 2022)

In terms of morphology, cirrhosis can be either (1) micronodular, (2) macronodular, or (3)
mixed. The etiologic classification is more clinically relevant than this one. (Sharma, 2022)

Micronodular cirrhosis (uniform nodules with a diameter of less than 3 mm): Hemochromatosis,
alcohol-related cirrhosis, chronic biliary obstruction, hepatic venous outflow obstruction, jejunoileal
bypass, and Indian childhood cirrhosis.

Micronodular cirrhosis (irregular nodules with a variation more than 3 mm in diameter): cirrhosis
caused by conditions known as alpha-1 antitrypsin deficiency, primary biliary cholangitis, and hepatitis
B and C.

Mixed cirrhosis: Generally, micronodular cirrhosis develops into macronodular cirrhosis over time,
exhibiting characteristics of both micronodular and macronodular cirrhosis.

According to the cirrhosis's etiology or cause, the subclassifications are as follows: (Sharma, 2022)

• Viral - hepatitis B, C, and D

• Toxins - alcohol, drugs
• Autoimmune - autoimmune hepatitis
• Cholestatic - primary biliary cholangitis, primary sclerosing cholangitis
• Vascular - Budd-Chiari syndrome, sinusoidal obstruction syndrome, cardiac cirrhosis
• Metabolic - hemochromatosis, NASH, Wilson disease, alpha-1 antitrypsin deficiency,
cryptogenic cirrhosis.

SYMPTOMS

Sharma (2022) discusses that depending on whether their cirrhosis is clinically compensated or
decompensated, patients with cirrhosis may either be asymptomatic or symptomatic. Patients with
compensated cirrhosis typically have no symptoms, and lab tests, physical examinations, or imaging
may accidentally find the illness. A typical finding is a slight to moderate increase in gamma-glutamyl
transpeptidase or aminotransferases, along with a possibly enlarged spleen or liver on the exam.
However, due to a confluence of portal hypertension and liver disease, patients with decompensated
cirrhosis typically exhibit a broad spectrum of signs and symptoms. The diagnosis of ascites, jaundice,
hepatic encephalopathy, variceal hemorrhage, or hepatocellular cancer in a patient with cirrhosis
denotes the transition from a compensated to a decompensated phase of cirrhosis. Hepatorenal
syndrome and spontaneous bacterial peritonitis are two further cirrhosis complications that affect ascites
patients.

Multiple organs are affected due to cirrhosis. Sharma (2022) has compiled the following:

Gastrointestinal. Individuals with chronic liver illness have a higher chance of gallstone formation,
and those with alcoholic cirrhosis are more likely to experience chronic pancreatitis and small intestinal
bacterial overgrowth.

Hematologic. Hemolytic anemia (spur cell anemia in severe alcoholic liver disease), hypersplenism,
and folate deficiency can all cause anemia. Patients with cirrhosis may experience hemosiderosis,
disseminated intravascular coagulation, pancytopenia from hypersplenism in portal hypertension, and
other conditions.

Renal. Patients who have cirrhosis are more likely to experience underfilling phenomenon because of
systemic hypotension and renal vasoconstriction, which can lead to hepatorenal syndrome. Renal
hypoperfusion was the result of cirrhosis-induced systemic vasodilation, which was further aggravated
by renal vasoconstriction, ultimately leading to renal failure.

Pulmonary. Hepatopulmonary syndrome, portopulmonary hypertension, hepatic hydrothorax,

decreased oxygen saturation, ventilation-perfusion mismatch, decreased pulmonary diffusion capacity,
and hyperventilation are some of the signs and symptoms of cirrhosis.

Skin. Patients with cirrhosis who have hyperestrogenemia as a secondary cause may develop spider
nevi, which are major arterioles encircled by numerous smaller arteries that resemble spiders, hence the
name. An imbalance in sex hormones brought on by liver disease results in an elevated ratio of estrogen
to free testosterone and the development of spider nevi. Additional skin abnormalities associated with
cirrhosis include palmar erythema and jaundice, or yellowish discoloration of the skin.

Endocrine. The onset of these illnesses has also been linked to hypothalamic-pituitary dysfunction.
Male hypogonadism can result in impotence and diminished desire along with feminization and loss of
secondary sexual traits. Infertility, irregular menstrual bleeding, and amenorrhea are all possible in
women.
Nail Changes. Dupuytren contracture, clubbing, and hypertrophic osteoarthropathy are seen. Muehrcke
nails, Terry nails, and azure lunules (a Wilson illness) are other nail alterations.

Others. Hepatic encephalopathy features that can be observed in cirrhosis include fetir hepaticus (a
sweet, musty-smelling breath smell caused by high blood levels of dimethyl sulfide and ketones) and
asterixis (a flapping tremor when the arms are extended and the hands are dorsiflexed). Cirrhosis can
also result in hyperdynamic circulation, a decrease in lean muscle mass, muscle cramps, and umbilical
herniation.

TREATMENT

The liver might sustain permanent damage. However, in order to stop the condition from getting
worse, more damage to the liver should be prevented. Avoiding alcohol, getting vaccinated against the
hepatitis B and hepatitis C viruses, maintaining a healthy weight, eating a balanced diet, and treating
infections and dehydration early on are all part of general therapy to prevent chronic liver disease. This
is accomplished through routine monitoring of kidney function, varices development, and the
advancement of varices to hepatocellular carcinoma. (Sharma, 2022)

Sharma (2022) discusses that the goal of specific therapy is usually to address the underlying
cause. For example, in cases of viral hepatitis, steroids and immunosuppressive drugs are used; in cases
of autoimmune hepatitis, ursodeoxycholic acid and obeticholic acid are used; in Wilson disease, copper
chelation is used; and in hemochromatosis, phlebotomy and iron chelation are used. In nonalcoholic
steatohepatitis, weight loss of at least 7% is helpful, while in alcoholic cirrhosis, abstinence from alcohol
is essential.

11. Plague

Known by many names, including "The Black Death" and "The Pestilence," the bubonic
plague is a dangerous contagious disease that has been prevalent for millennia. The earliest recorded
case was the Plague of Justinian, which occurred in AD 541–549. Between 15 to 100 million people
perished in the first plague pandemic, which struck Asia, Africa, and Europe in the 8th century.
Beginning with the Black Death (1346–1353), the second plague epidemic struck Europe and Northern
Africa in the 1700s, resulting in 75–200 million fatalities. This prompted the creation of public health
protocols such as quarantines, healthcare workers wearing protective gear, and the isolation of sick
individuals. After then, a number of incidents that began in 1855 and extended around the world until
1912 killed between 12 and 15 million people. China and India accounted for the majority of the
outbreaks. (Digit Insurance, 2024)
 Parry et al. (2020) revealed that even though the 1940s saw the development of antibiotics for
the plague, the WHO reported that the plague can kill between 50% and 60% of individuals who do not
receive treatment.

CAUSE

Yersinia pestis, arguably one of the most significant bacterial diseases in human history, is the
cause of the plague. When left untreated, it manifests in pandemics and epidemics with incredibly high
fatality rates. Humans have been afflicted by plague, a zoonotic infection, for thousands of years. The
three main plague syndromes that affect people are pneumonic, septicemic, and bubonic. These are all
the outcome of Yersinia pestis, a gram-negative bacillus infection. The normal course of Y. pestis’ life
cycle is first transmitted by an insect vector to a mammalian host, usually rats or other wild animals.
Only humans who are unintentional hosts are impacted. In spite of this, Y. pestis is undoubtedly, one of
the most significant bacteria in human history. (Dillard, 2023)

Yersinia pestis, a single member of the enterobacteria family, is the cause of the various clinical
manifestations of plague. Insects are the primary vector for these enzootic bacteria, which infects
rodents. The most frequent hosts are Rattus novegicus, or brown sewage rat, and Rattus rattus, or
domestic black rat; the most frequent and effective vector is Xenopsylla cheopis, or oriental rat flea.
Although there are numerous additional ways to get sick, humans usually get the bacteria through the
bite of an infected flea. There are reported cases of the plague contracted through ingestion of diseased
animals, inhalation of aerosolized germs, direct handling of animal tissue with open skin sores, and
human-to-human transmission. (Dillard, 2023)

SYMPTOMS

The most typical human manifestation of Yersinia pestis infection is the bubonic plague, which
starts with a flea bite and requires two to eight days to incubate. A skin lesion at the bite site may occur
in 25% of cases. Patients may present with pustular, vesicular, papular, or eschar-like lesions, which are
frequently undetected. Patients then suddenly get a fever, chills, headache, and general weakness. The
following day, a bubo appears. The bubo first manifests as severe pain in the vicinity of one or more
regional lymph nodes, usually the inguinal region, then the axillary or cervical nodes. After this, the
bubo region swells, and patients may experience such excruciating pain that they are immobile. A bubo
can be isolated or exist as a group of nodes, although the masses are usually non-varying and have an
excessively heated surface. Other aberrant vital signs include tachycardia and hypotension that
progresses to shock, in addition to fever. The physical exam may reveal hepatosplenomegaly in addition
to the bubo. (Dillard, 2023)
 According to Dillard (2023), all symptoms of septicemic plague are similar to those of bubonic
plague, but there is no associated bubo.
Pneumonic plague can arise from either the primary or secondary site of infection. It usually
follows the hematogenous spread of the bubo and is characterized by a high fever, cough, and
hemoptysis in addition to the usual plague symptoms. It can happen both with and without buboes.
Following inhalational exposure to another pneumonic plague patient who has a cough, primary
inhalational pneumonic plague develops. Meningitis, which typically results from untreated bubonic
plague, and pharyngitis, which appears similarly to other kinds of pharyngitis with substantial
inflammation of anterior cervical lymph nodes, are fewer common presentations. Prior to the
development of sepsis or buboes, the plague can occasionally also cause severe nausea, vomiting,
diarrhea, and abdominal discomfort, which might complicate the diagnosing process. (Dillard, 2023)

TREATMENT

Dillard (2023) argues that the foundation of every successful treatment for the plague is early
antibiotics because every disease subtype spreads quickly. Treatment should start on the basis of clinical
suspicion, as previously said, in light of these potentially severe clinical results. Aminoglycosides are
regarded as first-line therapy; in certain regions, gentamicin is currently the preferred medication over
streptomycin, the traditional first-line treatment. Tetracycline and doxycycline are alternatives;
however, because of the bacteriostatic properties of tetracyclines, treatment with these agents should be
prolonged from the usual 7 to 10 days to 14 days. Although it has been utilized, trimethoprim-
sulfamethoxazole has not been as effective as first-line treatments. The recommended course of
treatment for plague meningitis is chloramphenicol.

Levofloxacin was recently licensed by the US Food and Drug Administration for treatment in
humans suffering from plague, based on research conducted on animals and in vitro. There are
vaccinations to prevent Yersinia pestis infection, but none of them are widely used because of concerns
about their usefulness in preventing the spread of plague by bioterrorism. Up to 17 vaccinations are
being produced at the moment. (Dillard, 2023)

12. Cholera

The Digit Insurance (2024) has listed down cholera as one of the world’s deadliest diseases in
history. Since it first appeared in the Bengal region of India in 1817, cholera has produced seven
significant pandemics and has been there for centuries (most likely originating in the Indian
subcontinent). Unsafe water that has been tainted by the bacteria and human waste might expose people
to the infection. Dr. John Snow realized the significance of clean water for public health and
epidemiology—the study of how infectious illnesses spread—after a cholera outbreak occurred in
London in 1854.

The first cholera pandemic which affected Asia and Europe in 1817 to 1824 recorded more than
100,000 deaths. On the other hand, more than one million people were killed worldwide in the third
cholera pandemic that devastated from 1846 to 1860. The fourth cholera pandemic (1863-1875) killed
600,000 people while the sixth cholera pandemic (1899-1923) has resulted to the death of more than
800,000 people. (Digit Insurance, 2024)

Around 4 million cases of cholera are reported globally each year, and the illness is responsible
for over 140,000 fatalities. Almost 1.8 million people globally get their drinking water from sources
that are tainted with human waste, which could serve as a haven for the cholera germs. Epidemics are
known to happen, especially in underdeveloped nations where standards for water purification and
sanitation may be lacking. As of right now, cholera is thought to be endemic in about 50 countries,
primarily in Asia and Africa. Depending on when the region's rainy season occurs, the incidence is
linked to a seasonal distribution. However, in other parts of the world, such as South and Central
America, epidemics can be more widespread. Epidemic propagation has been observed to occur when
a species is introduced to an area where hygiene and health services have collapsed. (Fanous, 2023)

CAUSE

Cholera is an acute secretory diarrheal disease that is caused by the bacteria Vibrio cholerae. This
gastrointestinal illness is marked by high-volume fluid loss and electrolyte imbalances that can lead to
hypovolemic shock and, eventually, death. The infection can vary in severity and is spread by the fecal-
oral route. The facultative, gram-negative, comma-shaped, oxidase-positive rod Vibrio cholerae is
common in developing countries. Outbreaks have been linked to two serotypes. All recent epidemics
are caused by O1, whereas O139 occasionally produces outbreaks, particularly in Asia. The two are not
different etiologically. Poorly sterilized water and food—typically shellfish—are two sources of V.
cholerae. Due to its fecal-oral route of transmission, the bacteria are known to be endemic in regions
with poor standards of food and water hygiene. (Fanous, 2023)

According to Fanous (2023), the fecal-oral route is used to acquire the organism, and a high dose
is needed to become contagious. Among the factors that raise vulnerability are:

• Use of proton-pump inhibitors (PPIs) • Overcrowding

and antihistamines
• Prior vagotomy
• Having type 0 blood
• Helicobacter pylori infection
• Poor sanitation
 The small intestine may become colonized if V. cholerae is consumed. The creature may pass
through mucus and reach the gut wall thanks to its flagella. There, ganglioside receptors in the mucosal
wall are occupied by a toxin-coregulated pilus produced by toxigenic V. cholerae. The gut epithelium
produces cholera toxin. Consequently, elevated secretion of bicarbonate, potassium, sodium, and
chloride is noted. Diarrhea is caused by the osmotically drawn water out of intestinal cells by the
production of these electrolytes. (Fanous, 2023)

SYMPTOMS

The symptoms of cholera can vary, ranging from diarrhea to lack of symptoms. Vomiting, upset
stomach, and diarrhea are typical symptoms. Because severe cholera causes a significant and quick loss
of fluid and electrolytes, it can be clinically recognized from other diarrheal disorders. The feces are
frequently described as having a consistency similar to "rice water," and they may also contain mucus
and bile. A child's production can be as high as 20 cc/kg/hr, while an adult's can be as high as one liter
per hour. (Fanous, 2023)

The ensuing hypovolemia causes the typical signs and symptoms of fluid loss, such as chilly skin,
reduced skin turgor, and dry mouth mucosa. Lactic acidosis, which is brought on by inadequate bodily
tissue perfusion, can lead to hyperventilation and Kussmaul breathing. Additionally, generalized
muscular weakness and cramping may be caused by electrolyte imbalances such as hypokalemia and
hypocalcemia. (Fanous, 2023)

TREATMENT

The foundation of cholera treatment is timely fluid replacement according to the level of
volume loss. Oral rehydration solution should be administered if body weight loss is predicted to be
between 5% and 10%. Oral rehydration solutions based on rice have been demonstrated in clinical trials
to reduce the length of diarrhea and the volume of feces lost. One liter of water combined with six
tablespoons of sugar and half a teaspoon of salt can be used as a remedy in an emergency. Intravenous
fluids should be given to patients who have lost more than 10% of their body weight or who are in
hypovolemic shock. Throughout the first three hours, 100 mL/kg of lactated ringers should be given.
Fluids administered promptly can lower the fatality rate from over 10% to less than 0.5% in cases of
severe cholera. (Fanous, 2023)

Antibiotic therapy might start as soon as the patient reaches the proper volume condition. By far
the most widely utilized class is tetracyclines. The length of the disease can be shortened with a single
300 mg dose of doxycycline or 500 mg of tetracycline every 6 hours for two days. Alternative
treatments, however, include macrolides like azithromycin and erythromycin or fluoroquinolones like
ciprofloxacin, as resistance is frequent in some places. (Fanous, 2023)

13. Smallpox

According to Digit Insurance (2024), the origins of the smallpox are unknown and it has been
there for generations but the first large outbreaks occurred in Europe in the 18th century. The 2 million
deaths from the smallpox pandemic in Japan between 735–737 accounted for around one-third of the
country's population. The smallpox pandemic in Mexico in 1520 claimed the lives of 5–8 million
people, wiping out 40% of the population. In 1561, the Chile smallpox epidemic killed 20 to 25 percent
of their population. Between 1789 and 1790, a smallpox pandemic in New South Wales claimed the
lives of 50–70% of the indigenous population. However, the smallpox outbreak that struck Europe in
1870–1875 claimed 500,000 lives. 15,000 people died in India during the smallpox outbreak of 1974.

The World Health Assembly officially declared smallpox eradicated worldwide in 1980,
making it the first infectious disease affecting humans to do so. Because of worries about possible
release and weaponization, it is nevertheless important from a clinical standpoint. (Simonsen, 2023)

CAUSE

Simonsen (2023) discusses that the virus that causes smallpox belongs to the genus
Orthopoxvirus, family Poxvirus, and species Variola virus. The largest human viral diseases,
xenoviruses resemble bricks when viewed under an electron microscope. The Variola virus has a length
of between 300 and 350 nm. The poxviruses are distinct in that their genetic composition encodes every
protein required for replication, enabling them to replicate in the cytoplasm of the host cell. They have
a linear, double-stranded DNA genome.

Airborne respiratory droplet secretions or direct contact with lesions or contaminated fomites
are the two ways that smallpox is spread. Sloughing of oropharyngeal lesions and subsequent
aerosolization of viral particles liberate infectious viral particles. Transmission may happen from the
moment lesions appear until every crust has shed. It has been documented that smallpox can spread via
air in hospital and laboratory settings, hence increased infection control and isolation measures are
necessary. (Simonsen, 2023)

The virus moves to local lymph nodes after entering the body through the oropharynx or
nasopharynx, where it starts to replicate. On days three or four following infection, there is an initial
viremia. The virus then spreads to the spleen, bone marrow, and other lymph node chains. Between
days 8 and 12, following infection, a secondary viremia develops along with fever and other clinical
symptoms. At this point, the virus localizes in the dermal tiny blood vessels and oropharyngeal mucosa,
causing rash and clinical infectiousness. (Simonsen, 2023)

SYMPTOMS

According to Simonsen (2023), smallpox symptoms start off as a non-specific febrile prodrome,
which includes chills, a high temperature, stomach pain, vomiting, headaches, and backaches. The start
of skin lesions is one to three days prior to the febrile prodrome. Skin lesions usually start on the face
or forearms and progress to other parts of the body, usually including the palms and soles. Lesions are
less common on the torso and more common on the face and limbs. Throughout the course of the
sickness, lesions on one area of the body appear and progress at the same rate. Individual skin lesions
progress in stages over a period of 48 hours, changing from macules to papules, vesicles, pustules, and
crusts. After the rash first appears, it usually takes two to three weeks for all lesions to fully crust. The
lesions have a diameter of roughly 7 to 10 mm and appear to be well-circumscribed, spherical, firm,
and deeply seated.

TREATMENT

Before eradication, the main kind of treatment that was offered was supportive care. Research on
the creation of anti-orthopoxvirus pharmaceutical treatments is still ongoing in the post-eradication era.
2018 saw the US approve tecovirimat, the first antiviral medication recommended for the treatment of
smallpox. The antiviral has only been thoroughly tested in animal models, but it has also been given to
human participants in a safety study and as an emergency exploratory medication to individuals who
experienced side effects after the immunization. (Simonsen, 2023)

Smallpox has been successfully eradicated worldwide because to vaccination. Over time, a
number of smallpox vaccines have been created. The first was variolation, which involves purposefully
transferring infectious smallpox from an infected person's pustule to a healthy, non-immune individual
in order to cause a milder course of the disease. (Simonsen, 2023)

Simonsen (2023) writes that following eradication, scientists working on vaccinations have
developed live attenuated virus vaccines, viral subunit vaccines, and tissue-culture-based live vaccines
using advanced technology. In the worldwide context of an infection that has been eradicated, these are
required to enhance vaccination safety. The current recommendations for smallpox vaccinations only
cover those who are particularly at risk of exposure, such as certain healthcare workers, researchers,
and members of the US military.
 14. Typhus

Typhus has probably been existing for a very long time, although the first instances were
documented in 1489 AD which killed 17,000 people in Spain. Nonetheless, there have been several
outbreaks throughout history, most of which have begun in areas with unsanitary conditions and high
population density. Several other severe typhus epidemics were listed in the Digit Insurance (2024)
website. The typhus outbreak that struck Russia in 1812 claimed 300,000 lives. A typhus outbreak that
struck Ireland in 1817–1819 killed 65,000 lives. In the 1847 North American typhus pandemic, about
20,000 people lost their lives. There were two to three million deaths in Russia during the typhus
outbreak of 1918–1922.

According to Akram (2023), for generations, epidemic typhus has devastated humankind, killing
off large numbers of soldiers in conflict areas. In areas with low resources, there are foci of the typhus
epidemic during times of peace. Charles Nicole identified the human body louse, also known as
Pediculus humanus corporis, as the agent responsible for the spread of epidemic typhus. He was
awarded a Nobel Prize for his discovery in 1928. During World War II in the 1940s, vaccinations against
R. Prowazekii were effective in keeping US forces safe. The vaccinations are no longer created with
regular clinical usage in mind.

Akram (2023) discusses that it is rare for travelers to report epidemic typhus caused by Rickettsia
prowazekii. Epidemic typhus outbreaks have been localized in refugee populations where body lice are
common. These epidemics happen during the winter. The clinical context affects epidemic typhus
mortality differently. Patients who are elderly and malnourished have the highest fatality rates from
untreated primary infections, which can reach 60%. Patients with Brill-Zinsser disease (BZD) and
sylvatic typhus had significantly reduced death rates.

CAUSE

According to Svoboda (2018), there are three main kinds of typhus that are according to the
bacteria that caused it. People can contract murine typhus from fleas if they bite infected animals,
primarily rats. An uncommon kind of typhus called epidemic typhus is transmitted by infected body
lice. It is improbable to occur in environments other than densely populated housing. Flying squirrels
with the epidemic typhus virus can transmit the disease. But it's also extremely uncommon. Infected
chiggers, also known as mites, are the primary vectors of scrub typhus and are primarily prevalent in
rural areas of Southeast Asia, China, Japan, India, and northern Australia.

Since afflicted lice pass away five to seven days after contracting Rickettsia prowazekii, the
human body louse serves merely as a vector and not as a reservoir. The louse's gut epithelium becomes
infected with Rickettsia prowazekii, which subsequently separates, ruptures, and discharges rickettsiae
into the excrement. Via bite sites or skin abrasions, rickettsiae from contaminated feces reach their
human host. (Akram, 2023)

Rickettsiae prowazekii reaches the host's microcirculation and endothelial cells after that.
Rickettsiae prowazekii enters the cell, evades the phagosome, and multiplies in the cytoplasm. Since
Rickettsiae prowazekii lacks actin-based directed motility, it seldom enters the nucleus. Within the
endothelium cell, Rickettsiae prowazekii can proliferate until the cell ruptures, spilling its contents into
the extracellular area. (Akram, 2023)

The endothelial cells are injured by the rickettsiae multiplying, which produces the cell rupture.
Vasodilation and increased permeability of the vascular endothelium are caused by endothelial cell
damage. Increased vascular permeability can cause hypovolemia, hypotension, hypoalbuminemia, and
interstitial edema in extreme situations. Antidiuretic hormone secretion results in hyponatremia as a
reaction to hypovolemia. Noncardiogenic pulmonary edema is brought on by increased vascular
permeability in the pulmonary circulation. A picture of a serious failure of a multi-organ system
therefore emerges. (Akram, 2023)

SYMPTOMS

Svoboda (2018) reveals that the symptoms of typhus onsets 10 days to 2 weeks after being
infected with the typhus bacteria. This applies to all kinds of typhus. Svoboda (2018) listed down some
of the common symptoms of typhus:

• Chills
• Fever
• Headache
• Muscle aches like what you’d have with the flu
• A rash several days after the other symptoms start

However, there are additional symptoms for murine typhus, such as:

• Coughing • Stomach pain

• Loss of appetite • Vomiting
• Nausea
Other symptoms of epidemic typhus include:

• Confusion • Nausea
• Coughing • Vomiting
• Fast breathing
The scrub typhus can manifest symptoms of:

• Confusion or other mental impairment

• A dark scab on the area where the chigger bite
• Swollen lymph nodes

TREATMENT

According to Svoboda (2018), the Doxycycline is the most effective medication for treating all
three types of typhus. Doctors may select ciprofloxacin (Cipro) as an alternative antibiotic if the patient
is allergic to doxycycline or if it is ineffective.

Doxycycline 100 mg orally twice a day is the main treatment for epidemic typhus until the
patient recovers and has been afebrile for 24 to 48 hours. The course of treatment usually lasts seven to
ten days in total. An alternate course of treatment is 500 mg of chloramphenicol either orally or
intravenously four times a day for seven to 10 days. Supportive therapy along with intravenous fluids
is advised in severe instances. Patients in critical condition may have significant capillary permeability
and are more susceptible to cerebral and pulmonary edema. Therapy gets a quick response. There have
been documented cases of azithromycin therapy failing clinically. It is not advised that R receive
macrolides as therapy. prowazekii illness. (Akram, 2023)

15. HIV/AIDS

The virus known as Human Immunodeficiency Virus (HIV) that causes AIDS (acquired
immunodeficiency syndrome), was first discovered in 1981 and is thought to have originated in African
chimpanzees before spreading to humans in the early 20th century. (Digit Insurance, 2024)

According to Digit Insurance (2024), the disease was initially identified in the Democratic
Republic of the Congo in 1976, and for many years there was no treatment for it. However, with the
advent of new medications, HIV is today a lot more controllable chronic illness. Actually, as of early
2020, the number of deaths from HIV/AIDS fell from 2.2 million to 1.6 million year worldwide, and
two persons had even been cured of the virus.

Pandemic status is given to HIV infection. Estimates indicate that about 38 million individuals
are living with HIV infection now, and that 40 million people have died from HIV infection since the
virus's discovery. Due to recent improvements in therapy that have extended the lives of HIV patients,
the prevalence of HIV/AIDS has grown. In an effort to stop the virus's spread and treat it, there have
been AIDS-defining initiatives in the fields of research, education, and prevention. Since the 1990s,
there has been a decline in the annual number of new infections. Globally, the incidence of HIV and
AIDS varies greatly, despite efforts in industrialized nations leading to improvements in mortality,
quality of life, and transmission rates. There is currently no HIV vaccine available. (Waymack, 2023)

CAUSE

The human immunodeficiency virus is an enclosed retrovirus that carries two copies of its
single-stranded RNA genome (HIV). As the final stage of HIV disease, it results in acquired
immunodeficiency syndrome (AIDS). After HIV enters the body, the patient may experience initial
infection symptoms two to four weeks later. Following that, there is a protracted, chronic HIV infection
that can linger for decades. Opportunistic infections and tumors—which are typically lethal in the
absence of treatment—are the primary characteristics of AIDS. (Vaillant, 2022)

HIV is a sexually transmitted infection that can also be contracted through blood transfusions,
intravenous needle sharing, breastfeeding, and mother-to-child transmission. The phases of HIV
disease are as follows: viral transmission, acute seroconversion, acute retroviral syndrome, recovery
and seroconversion, asymptomatic chronic infection, and symptomatic HIV infection or acquired
immunodeficiency syndrome (AIDS). (Waymack, 2023)

HIV binds to the chemokine co-receptor CCR5 and the CD4 molecule. The virus's surface then
fuses with the cell membrane, allowing it to enter a T-helper lymphocyte. The HIV provirus arises upon
integration into the host genome, and is subsequently followed by transcription and the synthesis of
viral mRNA. The host cell produces and assembles the structural proteins of HIV. Millions of HIV
particles can be released by viral budding from host cells, which can then infect additional cells.
(Vaillant, 2022)

HIV is a spherical retrovirus that connects to host cells with glycoproteins where it targets
CD4T lymphocytes. Subsequently, the virus incorporates its chromosomal material into the host cell's,
seizing control of the cellular apparatus to produce further viral proteins and genetic material. The host
cell will eventually perish, and subsequent CD4 cells will become infected. This eventually cause these
cells to die and the infected person to become severely immunocompromised. The host immune system
is unable to fight against opportunistic infections and cancers once the CD4 level becomes too low. This
process involves the viral enzymes protease, reverse transcriptase, and integrase, which are the targets
of antiretroviral therapy (ART). The criteria for diagnosing AIDS in an HIV patient are the existence
of an AIDS-defining disease or a CD4 level of less than 200. Antiretroviral therapy (ART) is used to
treat AIDS by lowering the HIV viral load, treating the opportunistic sickness, and keeping an eye out
for an increase in CD4 cells. (Waymack, 2023)
 If treatment is not received, the majority of HIV-positive persons will develop AIDS within ten
years. The patient may live longer than ten years or even have a normal lifespan if antiretroviral therapy
is started as soon as they are diagnosed with AIDS. If a patient is diagnosed with AIDS and is not treated
with antiretroviral therapy (ART), they will likely pass away within two years. (Waymack, 2023)

SYMPTOMS

According to Vaillant (2022), after the exposure on HIV, many patients might only experience
an asymptomatic infection. Usually, it takes two to four weeks after exposure for symptoms to appear,
but occasionally, it takes up to ten months. Acute retroviral syndrome is a group of symptoms that can
manifest suddenly. Despite the fact that none of these symptoms are unique to HIV, their increasing
severity and length is a sign of a bad prognosis. The following is a list of these symptoms, decreasing
in frequency:

• Fatigue • Swollen lymph nodes

• Muscle pain • Joint pain
• Skin rash • Night sweats
• Headache • Diarrhea
• Sore throat
Both AIDS-positive and AIDS-negative individuals with chronic HIV infection can develop into
advanced HIV infection:

a) Chronic HIV infection without AIDS:

o Thrush o Bacillary angiomatosis
o Vaginal candidiasis o Cervical dysplasia
o Oral hairy leukoplakia o Cervical carcinoma in situ
o Herpes zoster o Constitutional symptoms
o Peripheral neuropathy o Idiopathic thrombocytopenic purpura
b) Chronic HIV infection with AIDS: defined as a CD4 cell count <200 cells/microL or the
presence of any AIDS-defining condition regardless of the CD4 cell count

o Multiple or recurrent bacterial infections

o Recurrent pneumonia
o Candidiasis
o Cervical cancer, invasive
o Coccidioidomycosis
o Cryptococcosis, extrapulmonary
 o Cryptosporidiosis, chronic intestinal
o Cytomegalovirus disease (other than liver, spleen, or nodes), onset at age
>1 month
o Cytomegalovirus retinitis (with loss of vision)
o HIV related encephalopathy
o Herpes simplex: chronic ulcers
o Histoplasmosis, disseminated or extrapulmonary
o Isosporiasis, chronic intestinal
o Kaposi sarcoma
o Lymphoma (Burkitt, immunoblastic or primary brain)
o Mycobacterium avium complex (MAC) or Mycobacterium kansasii,
disseminated or extrapulmonary
o Mycobacterium tuberculosis of any site
o Mycobacterium, other species or unidentified species, disseminated or
extrapulmonary
o Pneumocystis jirovecii
o Progressive multifocal leukoencephalopathy
c) Advanced HIV infection: defined as a CD4 cell count <50 cells/microL

TREATMENT

In order to treat HIV infections and AIDS, antiretrovirals are prescribed in different
combinations; this treatment is known as highly active retroviral therapy, or HAART. The antiretrovirals
comprise protease inhibitors, CCR5 inhibitors, integrase inhibitors, non-nucleoside reverse
transcriptase inhibitors (NNRTIs), nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), and
NRTI fixed-dose combinations. HAART is a lifelong treatment for HIV that should be initiated for all
patients, irrespective of their CD4 level. As long as the patient has a low or undetectable viral load, this
therapy has been demonstrated to reduce morbidity and death as well as the danger of spreading the
illness to others. (Vaillant, 2022)

a) Single Tablet Regimes:

o Efavirenz/emtricitabine/tenofovir disoproxil
o Rilpivirine/emtricitabine/tenofovir disoproxil
o Rilpivirine/tenofovir alafenamide/emtricitabine
o Elvitegravir /cobicistat/emtricitabine/tenofovir alafenamide
 o Elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil
o Dolutegravir/abacavir/lamivudine
b) Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): Abacavir, Emtricitabine,
Lamivudine, Zidovudine, Tenofovir disoproxil
c) NRTI Fixed-Dose Combinations:
o Abacavir/lamivudine
o Abacavir/lamivudine/zidovudine
o Emtricitabine/tenofovir disoproxil
o Lamivudine/zidovudine
d) Integrase Inhibitors: Dolutegravir, Raltegravir
e) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): Etravirine, Rilpivirine
f) CCR5 Inhibitor: Maraviroc
g) Protease Inhibitors: Atazanavir, Darunavir, Lopinavir /ritonavir, Atazanavir /cobicistat

Nystatin swishes can be used to treat oral thrush. If the patient is otherwise healthy, thrush can
be the only indication of an acute HIV infection. If there are any risk factors for HIV acquisition, a
confirmed diagnosis of HIV infection should be investigated. For the esophagitis patient who is
experiencing discomfort or dehydration, analgesia, water, and electrolyte replacement may also be
required. The preferred antibiotic in cases when diarrhea caused by Cryptosporidium is suspected, is
paromomycin. Standard antibiotics should be given to treat common bacterial pathogens when
meningitis is suspected. Radiation therapy, infrared coagulation, or cryotherapy are used to treat
Kaposi's sarcoma. Systemic chemotherapy might also be necessary, based on where or how severe the
Kaposi's is. Systemic antifungals like azoles can be used to treat a disseminated fungal infection that
manifests as cutaneous symptoms. Numerous common opportunistic infections can be attempted to be
prevented by starting prophylaxis. (Waymack, 2023)

Rehabilitation. In order to manage the pain associated with or made worse by HIV/AIDS, as well as
any remaining musculoskeletal, neurological, and cardiovascular abnormalities that arise as the disease
advances, providers usually send patients to therapy. It has been demonstrated that moderately intense
aerobic and resistance training helps patients without negatively affecting their viral load or CD4+
count, while yet enabling them to achieve notable increases in strength. The prognosis for HIV/AIDS
has improved, and as a result, work-related obstacles associated with managing this condition are
generally handled with medicines tailored to the patient's limitations and the physical demands of the
profession. (Waymack, 2023)
 16. Dengue Fever

Dengue is the world's fastest-growing viral disease spread by mosquitoes, affecting over 100
million people annually. Dengue is also present in more than 100 countries and is responsible for 20 to
25,000 deaths, most of them in children. Every year, epidemics strike Australia, Asia, Africa, and the
Americas. (Schaefer, 2022)

Schaefer (2022) notes that the patients' mean age was 34 years after 2010 as opposed to 27.2
years between 1990 and 2010. Both the frequency of severe dengue fever and the dengue virus serotype
responsible for illness outbreaks have changed throughout time.

There are two primary patterns of dengue transmission: epidemic dengue and hyperendemic
dengue. Epidemic dengue is the term used to describe cases where a single strain of the dengue virus
(DENV) is the cause of introduction and spread. Before World War II, dengue epidemics were more
common. All age groups are affected, but dengue hemorrhagic fever is not as common during an
epidemic. The term "hyperendemicity" describes the co-circulation of different DENV serotypes within
a community. The formation of hyperendemicity in a region is associated with periodic epidemics. DHF
(dengue hemorrhagic fever) affects children more often than adults, and its incidence is comparatively
higher. (Schaefer, 2022)

CAUSE

According to Schaefer (2022), the most common arthropod-borne viral disease in the world is
dengue, a virus spread by mosquitoes. Any one of the four unique serotypes (DENV1-4) of single-
stranded RNA viruses belonging to the genus Flavivirus is responsible for causing dengue fever.
Lifelong immunity to one serotype but not to others follows infection by that serotype.

The dengue virus is spread through two cycles: 1) mosquitos transmit the virus from one non-
human primate to another non-human primate, and 2) mosquitos transmit the virus from one human to
another human. The human-mosquito cycle is typically found in metropolitan settings. The viral load
of the mosquito's blood meal determines if the virus spreads from human to mosquito. (Schaefer, 2022)

Schaefer (2022) explains that female Aedes aegypti and Aedes albopictus mosquitoes are the
main carriers of the disease. While Aedes aegypti is linked to most infections, Aedes albopictus is
connected with a growing range, can withstand colder temperatures better, feeds aggressively but less
frequently, and may be linked to an increase in population. These mosquito species are mostly found
inside, where they are active during the day. There have been reports of transmission by organ
transplantation, breast milk, blood transfusions, and prenatal care.
 It's unclear exactly what happens when a mosquito bite injects the dengue virus into the skin.
Dendritic cells and skin macrophages seem to be the primary targets. It is believed that the contaminated
cells subsequently travel to the lymph nodes and disperse to other organs via the lymphatic system.
Before symptoms appear, viremia may be present for 24 to 48 hours. Then, a complicated interplay
between virus and host variables decides whether the infection will be asymptomatic, typical, or severe.
A second dengue virus serotype and the patient's immune system are assumed to be the cause of severe
dengue fever with enhanced microvascular permeability and shock syndrome. Severe dengue cases do,
however, happen when a single serotype is the source of infection. As virus titers decline, worsening
microvascular permeability frequently occurs. (Schaefer, 2022)

SYMPTOMS

Mayo Clinic (2022) reveals that many persons with dengue infections show no symptoms at
all. When symptoms do appear, they typically start four to ten days after being bitten by an infected
mosquito and can be confused with other illnesses, like the flu. Some of the symptoms are:

• High fever with the temperature of 104 F (40 C)

• Headache
• Muscle, bone or joint pain
• Nausea
• Vomiting
• Pain behind the eyes
• Swollen glands
• Rash

Most people heal in about a week. Sometimes the symptoms get worse and can prove fatal. This is
referred to as dengue shock syndrome, dengue hemorrhagic fever (DHF), or severe dengue.

Serious dengue fever warning signs can appear fast and are a life-threatening emergency. The
warning signals, which typically appear in the first day or two following the resolution of your fever,
may include:

• Severe stomach pain • Bleeding under the skin, which might look like
• Persistent vomiting bruising
• Bleeding from your gums or nose • Difficult or rapid breathing
• Blood in your urine, stools or vomit • Fatigue
• Irritability or restlessness
TREATMENT

Schaefer (2022) explains that the stage of the patient's illness determines how the disease is
treated. Acetaminophen and enough oral fluids can be used as an outpatient treatment for those who
appear early and show no warning symptoms. Patients who exhibit warning signs, have severe dengue,
or are in other categories such as elderly, pregnant, single, or in infancy, should be admitted. IV
crystalloids can be started for those who exhibit warning signals, and the patient's response will
determine how much fluid is added gradually. Colloids are recommended if the patient has already
received boluses of crystalloid and has not responded, however they can be started for patients who are
in shock. When a patient is bleeding severely or is suspected of bleeding and their hematocrit drops
even after receiving enough fluid resuscitation, a blood transfusion is necessary. When there is a high
risk of bleeding and the platelet count falls to less than 20,000 cells/microliter, platelet transfusion is
recommended. Refrain from administering anticoagulants such as aspirin and nonsteroidal anti-
inflammatory medications. The use of antiviral drugs is not advised.

17. Malaria

Buck (2023) reveals that each year, two billion people—including 125 million tourists and
residents of 90 endemic countries—run the risk of contracting malaria. Annually, 40% of the world's
population either lives in or travels to areas where malaria is endemic. There are up to 500 million cases
of malaria and 1.5–2.7 million fatalities yearly. In Africa, ninety percent of deaths happen. Children
under five, expectant mothers, and communities that are unfamiliar with disease—such as refugees in
Central and Eastern Africa, non-immune civilian and military travelers, and immigrants returning to
their country of origin—are the groups most at danger.

Ten thousand to thirty thousand of the 125 million tourists that visit endemic areas each year have
malaria; of them, one percent will pass away from illness-related complications. It is predicted that
changes in weather patterns and rising world average temperatures will increase the prevalence of
malaria; an increase of 3 degrees Celsius is thought to increase malaria incidence by 50–80 million
cases. (Buck, 2023)

CAUSE

Anopheles mosquitoes carry the parasite pathogen malaria, which can cause acute, life-
threatening sickness and is a major danger to global health. The multistage life cycle of the Plasmodium
parasite causes distinctive cyclical fevers. (Buck, 2023)
 Buck (2023) states that humans can contract malaria from five different species of Plasmodium:
Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, and
Plasmodium knowlesi. During a blood meal, the female Anopheles mosquito consumes gametes, which
develop into sporozoites that multiply in the stomach. Saliva carrying sporozoites is discharged into the
bloodstream of a human host during successive bloodmeals. Sporozites enter the liver in less than an
hour, infiltrate hepatocytes, and then quickly proliferate to form merozoites. Hemoglobin is consumed
by plasmodia when they progress into mature trophozoites or gametocytes from immature trophozoites
(ring stage) (CDC Malaria 2019). The replication of mature trophozoites results in the formation of
schizonts, damage to the integrity of the erythrocyte cell membrane, capillary endothelial adhesion, and
cell lysis.

According to Buck (2023), Plasmodia vivax and Plasmodia ovale infections can show signs of
"dormant schizogony," a condition in which hypnozoites, or dormant intrahepatic parasites, persist until
they reactivate months or years later. There are few reports of resurgent Plasmodia falciparum infection
years after first exposure, despite the fact that hypnozoite parasites do not regularly form in the liver in
the setting of Plasmodia falciparum and Plasmodia malariae infection.

SYMPTOMS

Mayo Clinic (2023) list down the possible symptoms of malaria:

• Fever • Abdominal pain

• Chills • Muscle or joint pain
• General feeling of discomfort • Fatigue
• Headache • Rapid breathing
• Nausea and vomiting • Rapid heart rate
• Diarrhea • Cough

Malaria "attacks" can occur in cycles for certain patients; an attack often begins with chills and
shivering, progresses to a high fever, then sweats and returns to normal temperature. Usually starting a
few weeks after being bitten by an infected mosquito, malaria signs and symptoms manifest. Certain
malaria parasite species, however, can remain dormant in the body for up to a year. (Mayo Clinic, 2023)

TREATMENT

Patients with malaria diagnosis receive supportive treatment, hospitalization for high-risk
patients, and schizophrenia-specific medication. In order to guarantee appropriate and timely medicine
administration and to track parasitemia trends in order to assess treatment response, naïve adult and
pediatric patients undergoing active antimalarial treatment should stay hospitalized for a minimum of
24 hours. Critical care is necessary for unstable patients, especially those with cerebral malaria or severe
respiratory sequelae. Higher initial parasitemia and a poor decline are linked to fluid imbalance, renal
failure, and respiratory distress syndrome. (Buck, 2023)

Buck (2023) explains that combination therapy is used to treat both the erythrocytic and hepatic
types. Chloroquine, hydroxychloroquine, primaquine, artemisinin-based combination therapy (ACT),
and atovaquone-proguanil are the main antimalarial medications.

18. Ebola

Ebola virus belongs to the Filoviridae family. The term "filum" in Latin, which means thread,
is where the name originated. The filamentous virus resembles a twisted thread in appearance. Since it
initially surfaced in 1976 beside the Ebola River, the virus has been named after it. Eating meat from
non-human primates infected with the Ebola virus, such as chimpanzees, monkeys, and apes, is the
working theory behind the zoonotic vector that spreads the virus to humans. Bats are a source of
Ebolavirus strains. Its transfer to humans has not yet been established, though. (Patel, 2023)

Parry (2020) discuss the largest Ebola outbreak happened in West Africa started in 2014. 28,652
suspected and confirmed cases of the virus had been documented by the time the outbreak concluded
in 2016, accounting for about 11,325 deaths. The Democratic Republic of the Congo declared an Ebola
outbreak in its northern province of Kivu in August 2018. As of February 2020, that outbreak had killed
2,246 people and infected 3,428 others. In 2019, the rVSV-ZEBOV immunization for close contacts of
Ebola patients was approved.

Pattel (2023) adds that when the Ebola virus was first identified in 1976, it was thought to be
an uncommon, exotic illness that was mostly being researched in extremely secretive labs. More than
20 outbreaks have happened since its discovery in 1976; many of these outbreaks were limited to rural
areas in Uganda, Sudan, Gabon, the Democratic Republic of the Congo, and the Republic of the Congo.
Ebola epidemics that are endemic, primarily the Zaire and Sudan ebolavirus, are linked to the
consumption of tainted monkey meat. Funeral customs and family members are typically the first to
catch the virus, followed by members of the community. A number of epidemics were brought on by
laboratory contamination.

The ebolavirus strain determines the death rate, which varies from 25% to 90%. Zaire strain,
the deadliest strain, used to be 90% lethal. With greater knowledge, instruction, and early identification,
the average death rate is now almost 50%. The only times the Ebola virus can spread are when a person
has prodromal symptoms including fever, chills, nausea, vomiting, or contact with infected deceased
corpses. The virus is considered a dangerous biowarfare agent because of its manner of dissemination
and concerning case-fatality rate. (Patel, 2023)
CAUSE

Hemorrhagic fever is a deadly and highly contagious infection caused by the Ebola virus. They
are the most frequent to infect primates and people, leading to hemorrhagic fever, which can be fatal.
Based on topographic discoveries, the Ebolavirus has five subtypes: Zaire, Bundibugyo, Sudan, Reston,
and Tai Forest. The Pteropodidae family of fruit bats is thought to be the natural host of the Ebola virus,
according to the World Health Organization. (Patel, 2023)

Humans who are infected can spread the virus by coming into touch with bodily fluids such as
blood, urine, feces, sweat, breast milk, semen, or fomites. It's interesting to note that up to 21 days after
the patient recovers, the Ebola virus might persist in semen. Regarding whether vaginal fluids contain
or disseminate the Ebola virus, there is currently conflicting information. Once a host is infected, the
virus will incubate there for an asymptomatic, non-contagious period of time that typically lasts a few
days to a few weeks. A person who is afflicted and displaying symptoms similar to a common viral
infection is deemed infectious. (Patel, 2023)

According to Patel (2023), breaks in the skin or mucosal membranes allow the virus to enter its
new host. The virus might enter the host without causing harm to the mucosal barrier. The duration of
the virus's survival outside of the human body is unknown. In order to prevent contamination and the
possibility of the virus spreading, the bedding, clothing, and medical utensils used on patients are
typically burnt or disposed of as medical waste.

SYMPTOMS

The virus has an incubation period of two to twenty-one days after it infects the host. Death can
happen extremely quickly once symptoms appear, frequently within six days. The extremely virulent
virus causes immune-mediated cell damage that impairs organ function in several essential organs,
including the liver, kidney, heart, and lungs. It also activates the innate and adaptive immune systems.
whose harmful consequences result in organ failure affecting multiple systems. Individuals who make
a full recovery have developed antibodies against the Ebola virus. On the other hand, long-term effects
such hepatitis, psychosis, uveitis, and spinal cord injury have been noted. (Patel, 2023)

One of the five types of the Ebola virus is the source of the frequently fatal infection known as
Ebola virus disease (EVD). Rapid viral spread overcomes the body's immune system and causes fever,
headaches, weakness, diarrhea, vomiting, and stomach pain in addition to headaches and muscular
aches. Hemorrhagic syndrome is the term for the illness that occurs in some Ebola patients as the disease
progresses and causes bleeding from the mouth and nose. (Parry, 2020)
TREATMENT

Supportive care is the cornerstone of managing and treating individuals who have contracted
the Ebola virus and are displaying signs of the disease. regulating temperature with antipyretics and
repeating fluid loss with intravenous fluid and electrolyte therapy. . (Patel, 2023)

During the most recent Ebola virus outbreak, intense emergency research yielded promising
results in addition to supportive care. This research concentrated on antiviral medications including
remdesivir, monoclonal antibodies, and convalescent plasma as therapeutic therapies. Preventative
measures are among the best forms of treatment; numerous vaccinations have been created. An
important non-medical strategy is further prevention of spread by enforcing international travel bans
and exit inspections when leaving countries with active Ebola outbreaks. . (Patel, 2023)

19. Rabies

Koury (2022) reveals that an estimated 30,000 to 70,000 people die from rabies-related viral
encephalitis each year; the number of deaths from this illness is higher in less developed nations. With
cases reaching back more than 4,000 years, rabies is one of the oldest known diseases in human history.
An animal's bite from a rabid animal was always fatal for the majority of human history. Many used to
commit suicide after getting bitten by an animal that might have been rabid because they were so afraid
of contracting rabies. In developed countries, Pasteur's 1885 rabies vaccine has resulted in widespread
prophylaxis; but less developed nations are not as fortunate.

CAUSE

The most typical way for the virus to spread is by mammal bite, both domestic and wild.
However, saliva can also spread the virus through cuts in the skin or mucous membranes. Additional
methods of infection include ingesting the virus, transplacentally, inhaling it in an aerosolized form, and
even receiving an organ transplant. About 10% of rabies cases in developed nations have been spread
by domesticated animals; the majority of instances are caused by wild animals including skunks,
raccoons, foxes, and bats in particular. Since any mammal can contract rabies, even though small
rodents and members of the rabbit family are generally thought to be safe because it is unlikely that
they would survive an inoculating wound from a rabid animal, there have been anecdotal occurrences
of rabies contracted from rats. (Koury, 2022)
SYMPTOMS

After infection, the rhabdovirus targets the central nerves as it moves through the peripheral
nervous system, causing encephalomyelitis. The initial signs of a viral illness in humans resemble those
of any other nonspecific illness (fever, malaise, headache). After that, these mild symptoms could
intensify into agitation, anxiety, and finally open delirium. Within the first several days following a
rabid bite, tingling at the bite site is one extremely common symptom. It's interesting to note that the
virus returns to the peripheral nervous system after first spreading to the central nervous system, where
it mostly affects highly innervated regions like the salivary glands. (Koury, 2022)

The cause of the "frothing" is hypersalivation; with the sight, taste, or sound of water, sufferers
may experience severe spasms of the pharynx. This is referred to as "hydrophobia." Eventually, the
virus causes the entire nervous system to collapse completely, leading to a rapid death. Animals
typically pass away in 10 days, but the incubation time after vaccination might extend up to six years,
with an average of a few months. The location of exposure, the degree of the wound, and the viral load
all influence the time of onset. In the end, the virus damages the central nervous system, with the
brainstem typically suffering more severe effects. The inflammatory response triggers the toxic effects,
which are accompanied by functional alterations that are not fully understood. The virus may ultimately
impact neurotransmission, and both viral-dependent and cell-dependent pathways may lead to
apoptosis. Rabies is always lethal as soon as clinical signs appear. (Koury, 2022)

After inoculation, rabies progresses through five stages: incubation, prodrome, severe
neurologic disease, coma, and death. Koury (2022) explains the different stages:

Incubation. This refers to the time span from the point of vaccination to the first signs and symptoms,
which can appear days or years later.

Prodrome phase. Myalgias, fevers, and gastrointestinal problems are a few of the nonspecific
symptoms that are comparable to flu-like conditions.

Third stage of rabies. The neurological symptoms manifest. These fall into one of three groups:

Encephalitic (often called "furious"). This is the most common form which manifests in about
85% of cases. These individuals can have aerophobia or hydrophobia. During the encephalitic
form, there may be agitation, alterations in mentation, autonomic dysfunction, increased deep
tendon reflexes, nuchal rigidity, and positive Babinski sign. Exam results pertaining to areas
other than the neurological system may include fever, tachypnea, and tachycardia. This quickly
develops into hyperactivity.

Paralytic (sometimes called "dumb"). Less than 20% of cases of rabies are reported to be
paralytic. Since irritability is absent and hydrophobia is often linked with Guillain-Barre
 syndrome, these patients may be misdiagnosed with the condition. The main symptom is
weakness, although other symptoms include bladder dysfunction, persistent fevers, and
changed mentation.

Rare non-classic form. Typically, it is linked to seizures as well as more severe motor and
sensory problems.

Coma stage. The coma stage of stage 4 rabies often starts 10 days after stage 3 symptoms appear.
Patients may experience flaccid paralysis, protracted apnea episodes, and persistent hydrophobia.

Death. Without supportive care because of cardiopulmonary failure, most patients die within two to
three days of stage 4 onset. Almost no patients recover from rabies, not even with supportive treatment.
It is rare for someone who exhibits rabies symptoms to survive. For those who have received the rabies
vaccine but do not exhibit symptoms, survival is guaranteed. People who are bitten by a rabid animal
must receive the rabies vaccination and immunoglobulin as soon as possible in order to survive; once
the symptoms materialize, death is certain.

TREATMENT

According to Koury (2022), effective treatment for rabies does not exist. The cornerstone of
treatment, including initiatives for monitoring, education, and vaccination of domestic animals, is
prevention.

The initial course of therapy for anyone who has been exposed to rabies is wound care. If
wounds are attended to appropriately within three hours of inoculation, it has been seen that this alone
is nearly 100% effective. The recommended course of action involves cleaning the incision and its
surroundings using soap and water (solutions such as 20% soap solution, povidone, and alcohol
solutions), as well as thoroughly swabbing puncture wounds while providing irrigation. It is advised to
apply a virucidal treatment, such as povidone-iodine or benzalkonium chloride, after carefully cleansing
the wound. (Koury, 2022)

The start of treatment is then determined by whether or not the patient has had prior
vaccinations. A human diploid cell vaccine or a pure chick embryo cell vaccine administered
intramuscularly twice day at a dose of 1 mL is a common course of treatment for patients who have
already received vaccinations. Even if the patient has never been immunized, the course of treatment
still entails intramuscular injection of one milliliter of one of the two vaccinations mentioned above on
days 0 through 14 (or day 28 if the patient is immunosuppressed). The location of the vaccination dosage
should be separate from the location of the second therapy component, which is the administration of
human rabies immune globulin, or HRIG. (Koury, 2022)
 20. Coronavirus

With over 6 million deaths globally, COVID-19 has had a devastating impact on the planet.
SARS-CoV-2 spread quickly throughout the world after the first instances of this primarily respiratory
viral disease were recorded in Wuhan, Hubei Province, China, towards the end of December 2019. On
March 11, 2020, the World Health Organization (WHO) was forced to declare it a global pandemic as
a result. (Cascella, 2023)

According to Cascella (2023), despite significant advancements in clinical research leading to a

better knowledge of SARS-CoV-2, outbreaks of this virus persist in several countries. The primary
cause of these outbreaks is thought to be the emergence of viral mutants. SARS-CoV-2 adapts through
genetic evolution and the development of mutations, just as other RNA viruses. As a result, mutant
variations are produced that could differ from their parent strains in some ways. During the course of
this pandemic, several SARS-CoV-2 variations have been identified; however, only a small number of
these are regarded as variants of concern (VOCs). Since the start of the epidemic, five SARS-CoV-2
VOCs have been discovered, according to the WHO's epidemiological update:

• Alpha (B.1.1.7): First variant of concern, which was described in the United Kingdom
(UK) in late December 2020
• Beta (B.1.351): First reported in South Africa in December 2020
• Gamma (P.1): First reported in Brazil in early January 2021
• Delta (B.1.617.2): First reported in India in December 2020
• Omicron (B.1.1.529): First reported in South Africa in November 2021

CAUSE

The extremely contagious virus known as Coronavirus disease 2019 (COVID-19) is caused by
the SARS-CoV-2 virus, which causes severe acute respiratory syndrome. Exposure to respiratory
droplets containing the infectious virus through close contact or direct transmission from
presymptomatic, asymptomatic, or symptomatic patients harboring the virus are the main ways that
SARS-CoV-2 is spread. (Cascella, 2023)

Cascella (2023) explains that the dissemination of COVID-19 has also been linked to aerosol-
generating processes used in airborne transmission. There is evidence that SARS-CoV-2 can spread by
air when aerosol-producing processes are not in place, however this method of transmission is not
widely recognized.

Cascella (2023) mentions that based on several investigations documenting the survival of
SARS-CoV-2 on diverse porous and nonporous surfaces, the mechanisms behind the fomite
transmission from contamination of inanimate surfaces with the virus have been thoroughly
documented. According to the Centers for Disease Control and Prevention (CDC), contact with infected
surfaces can result in SARS-CoV-2 infection, however this is not the primary method of virus
transmission and the risk is minimal.

According to Cascella (2023), patients with SARS-CoV-2 infection contain the live virus in
their feces, according to epidemiologic data from multiple case investigations, suggesting a potential
fecal-oral transmission.

Although it happens seldom, vertical transmission of COVID-19 is a possibility, according to

a meta-analysis involving 936 newborns from women who had the virus. (Cascella, 2023)

People of all ages are susceptible to this virus. Patients 60 years of age or older, as well as those
with underlying medical conditions (such as obesity, cancer, solid organ or hematopoietic stem cell
transplant patients, diabetes, obesity, cardiovascular disease, and chronic kidney disease), are more
likely to develop a severe COVID-19 infection. (Cascella, 2023)

SYMPTOMS

COVID-19 is classified into five separate categories by the National Institutes of Health (NIH) based
on the severity of the presenting illness, which includes clinical symptoms, laboratory and radiographic
abnormalities, hemodynamics, and organ function. (Cascella, 2023)

Asymptomatic or Presymptomatic Infection: Individuals with positive SARS-CoV-2 test

without any clinical symptoms consistent with COVID-19.

Mild illness: Individuals who have symptoms of COVID-19, such as fever, cough, sore throat,
malaise, headache, muscle pain, nausea, vomiting, diarrhea, anosmia, or dysgeusia but without
shortness of breath or abnormal chest imaging.

Moderate illness: Individuals with clinical symptoms or radiologic evidence of lower

respiratory tract disease and oxygen saturation (SpO2) ≥94% on room air.

Severe illness: Individuals who have SpO2 less than 94% on room air, a ratio of partial pressure
of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) of less than 300, marked
tachypnea with a respiratory frequency of greater than 30 breaths/min, or lung infiltrates that
are greater than 50% of total lung volume.

Critical illness: Individuals with acute respiratory failure, septic shock, or multiple organ
dysfunction. Patients with severe COVID-19 illness may become critically ill with the
 development of acute respiratory distress syndrome (ARDS). This tends to occur approximately
one week after the onset of symptoms.

TREATMENT

The National Institutes of Health (NIH) states that the two primary mechanisms underlying the
pathophysiology of COVID-19 are the virus's replication during the early stages of the illness and the
immune system's dysregulated reaction to SARS-CoV-2, which results in systemic tissue damage during
the later stages of the disease. Therefore, the guidelines recommend using immunomodulators in the
later stages of the illness and antiviral drugs in the early stages to stop virus replication. (Cascella, 2023)

According to Mayo Clinic (2023), Remdesivir (Veklury), an antiviral medication, has been
licensed by the FDA to treat COVID-19 in hospitalized adults and children 12 years of age and older.
Remdesivir may be recommended for COVID-19 hospitalized patients who require extra oxygen or
who are at a higher risk of developing a major disease. It is administered by intravenous needle.

Another medication authorized for treating COVID-19 in adults is called paxlovid. It contains
the antiviral medication ritonavir, which aids in slowing the breakdown of nirmatrelvir, and the
medication nirmatrelvir, which inhibits the function of a certain enzyme required for the virus that
causes COVID-19 to proliferate. Pills called paxlovid are used orally. (Mayo Clinic, 2023)

Additionally, the FDA has authorized the use of the rheumatoid arthritis medications
tocilizumab (Actemra) and baricitinib (Olumiant) in some COVID-19 cases. One medication that
appears to be effective against COVID-19 is baricitinib, which has antiviral and anti-inflammatory
properties. As an injectable, tocilizumab is used. It appears to function by lowering inflammation in
response to COVID-19. Patients with COVID-19 who require extra oxygen or are on mechanical
ventilation may receive both medications while they are in the hospital. (Mayo Clinic, 2023)

Molnupiravir (Lagevrio) is a medication that has been approved by the FDA to treat mild to
moderate COVID-19 in people who are at risk of serious disease and are unable to take other forms of
treatment. The medication is swallowed as a tablet. (Mayo Clinic, 2023)

The corticosteroid dexamethasone is advised by the U.S. National Institutes of Health for
patients with severe COVID-19 who are hospitalized and require mechanical breathing or
supplementary oxygen. If dexamethasone is not available, other corticosteroids such hydrocortisone,
methylprednisolone (Medrol), or prednisone may be used instead. (Mayo Clinic, 2023)

When a patient is on mechanical ventilation or requires extra oxygen in the hospital,

dexamethasone may occasionally be administered along with the medications remdesivir, tocilizumab,
or baricitinib. (Mayo Clinic, 2023)
 Mayo Clinic (2023) mentions that in order to treat COVID-19, the FDA has additionally
approved COVID-19 convalescent plasma therapy with high antibody levels. Blood donated by
individuals who have recovered from COVID-19 is known as convalescent plasma. Those with
compromised immune systems who have been diagnosed with COVID-19 may benefit from
convalescent plasma with elevated antibodies.

Many COVID-19 patients may only have moderate symptoms that respond well to supportive
therapy. Mayo Clinic (2023) has listed down the goal of supportive care is to reduce symptoms, and it
could involve:

• Pain relievers, such as ibuprofen or acetaminophen.

• Cough syrup or medicine.
• Rest.
• Fluid intake.

When it's feasible, use air filters and open windows to improve ventilation at home. The medical
team will probably advise the patient to remain isolated at home for a while, unless they need medical
attention. The physician will probably conduct routine follow-ups. (Mayo Clinic, 2023)
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