Human diseases : Communicable & Non Communicable Diseases, Acute and Chronic Diseases; Causes and Prevention of Infectious, Genetic and Lifestyle Disease.

Diseases – Communicable diseases, Endemic diseases

Top 10 Causes of Death (Source: WHO World Health Statistics 2012)

• Ischemic heart disease 12 %
• Chronic obstructive pulmonary disease 11%
• Stroke 9%
• Diarrheal disease 6%
• Lower respiratory infections 5%
• Preterm birth complications 4%
• Tuberculosis 3%
• Self-inflicted injuries 3%
• Falls 3%
• Road injuries 2%

Communicable diseases

• Communicable diseases continue to be a major public health problem in India.
• Many communicable diseases like tuberculosis, leprosy, vector borne diseases like malaria, kalaazar, dengue fever, chikungunya, filariasis, Japanese encephalitis, water-borne diseases like cholera, diarrhoeal diseases, viral hepatitis A & E, typhoid fever, leptospirosis, etc and other viral infections are endemic in the country.
• In addition to these endemic diseases, there is always a threat of new emerging and re-emerging infectious diseases like nipah virus, avian influenza, SARS, novel H1N1 influenza, hanta virus etc.
• Local or widespread outbreaks of these diseases result in high morbidity, mortality and adverse socio-economic impact.

The most common diseases which are endemic in India are as follows:

Communicable Disease- Malaria:

• Malaria is a very common disease in developing countries. The word malaria is derived from the word ‘mal-aria meaning bad air.
• Ronald Ross first discovered the transmission of malaria by mosquitoes, while he was working in India (Secunderabad, AP) in 1897. Malaria is one of the most widespread diseases in the world.
• Each year, there are 300 to 500 million clinical cases of malaria, 90 percent of them in Africa alone.
• Among all infectious diseases, malaria continues to be one of the biggest contributors to disease burden in terms of deaths and suffering.
• Malaria kills more than one million children a year in the developing world, accounting for about half of malaria deaths globally.
• The risk of getting malaria extends to almost the entire population in India (almost 95 percent).
• The following states that have the highest number of malaria cases are Madhya Pradesh, Maharashtra, Orissa, Karnataka, Rajasthan, Assam, Gujarat and Andhra Pradesh.

Communicable Disease- Typhoid:

• Typhoid fever is an acute, systemic infection presenting as fever with abdominal symp­toms, caused by Salmonella typhi and paratyphi.
• Before nineteenth century, typhus and typhoid fever were considered to be the same. Enteric fever is an alternative name for typhoid. Salmonella typhi and paratyphi colonise only humans.
• The organisms are acquired via ingestion of food or water, contaminated with human excreta from infected persons.
• Direct person-to-person transmission is rare. Typhoid is a global health problem. It is seen in children older than the age of one.
• Outbreak of typhoid in developing countries results in high mortality. The recent development of antibiotic resistant organisms is causing much concern.
• Typhoid fever is more common in the tropics. It tends to occur in places, where the sanitation standards are poor. A bacterial organism called salmonella typhi causes typhoid fever.
• Salmonella paratyphi can also cause fever and abdominal symptoms. The disease caused by both these entities is called enteric fever.
• The disease presents with a typical, continuous fever for about three to four weeks, relative bradycardia with abdomi­nal pain (due to enlargement of lymph nodes in the abdomen), and constipation.
• Geographical Distribution Worldwide, typhoid fever affects about six million people with more than 6, 00,000 deaths a year.
• Almost 80 percent of cases and deaths occur in Asia, and most others in Africa and Latin America. Among Asian countries, India prob­ably has a large number of these cases.

• Indian Statistics Typhoid fever is endemic in India.
• Health surveys conducted by the Central Ministry of Health in the community development areas indicated a morbidity rate varying from 102 to 2,219 per 1, 00,000 population in different parts of the country.
• A limited study in an urban slum showed 1 percent of children up to 17 years of age suf­fer from typhoid fever every year.
• Carriers of Typhoid Fever Typhoid infection is mainly acquired from persons who are carriers of the disease.
• Carriers are the people who continue to excrete salmonella through their urine and feces a year after an attack of typhoid. A chronic carrier state develops in about 2 to 5 percent of the cases.
• The organisms in such cases make the gall bladder their habitat.

Communicable Disease- Hepatitis:

• Hepatitis is the inflammation of liver. It can be caused by viruses (five different viruses— termed A, B, C, D and E cause viral Hepatitis), bacterial infections, or continuous expo­sure to alcohol, drugs, or toxic chemicals, such as those found in aerosol sprays and paint thinners, or as a result, of an auto-immune disorder.
• Hepatitis results in either damage or reduction in the livers ability to perform life-preserving functions, including filtering harmful, infectious agents from blood, storing blood sugar and converting it into usable energy forms, and producing many proteins necessary for life.
• Symptoms seen in Hepatitis differ according to the cause and the overall health of the infected individual. However, at times, the symptoms can be very mild.
• The com­monly seen clinical features are general weakness and fatigue, loss of appetite, nausea, fever, abdominal pain and tenderness.
• The main feature is the presence of jaundice (yel­lowing of skin and eyes that occurs when the liver fails to break-down excess yellow- coloured bile pigments in the blood).
• Depending on the progress and intensity, Hepatitis can be categorized as acute or chronic. In acute Hepatitis, clinical features often subside without treatment within a few weeks or months. However, about 5 percent of the cases go on to develop into chronic Hepatitis, which may last for years. Chronic Hepatitis slowly leads to progressive liver damage and cirrhosis.

Hepatitis A:

• Hepatitis A is a self-limiting disease that is found all across the world.
• It is usually transmitted through oral ingestion of infected material (mainly water), but sometimes transmitted parenterally; most cases resemble the symptoms of a mild flu attack and jaundice is mild too.

Hepatitis B:

• Hepatitis B is an acute vital disease. It primarily spreads parenterally, but sometimes orally as well.
• However, the main mode of spread is intimate contact and from mother to the new born.
• Fever, anorexia, nausea, vomiting are the initial symp­toms, and they soon lead to severe jaundice, urticarial skin lesions, arthritis, etc.
• Some patients become carriers or even remain chronically ill, even though most patients recover in about three to four months.

Hepatitis C:

• Hepatitis C is a viral disease commonly occurring after transfusion or par­enteral drug abuse.
• It frequently progresses to a chronic form that is usually asympto­matic, but may involve liver cirrhosis.

Hepatitis D:

• Hepatitis D or Delta Hepatitis is caused by the Hepatitis D virus.
• It usually occurs simultaneously with or as a super infection in case of Hepatitis B, thus increasing its severity.

Hepatitis E:

• Hepatitis E is transmitted by the oral fecal route; usually by contaminated water.
• Chronic infection does not occur but acute infection may be fatal in pregnant women.

Communicable Disease- Jaundice:

• Jaundice, also known as icterus, is a condition, which is characterized by yellowish dis­colouration of the skin and whites of eyes. It is a symptom or clinical sign, not a disease by itself.
• The yellow colouration is caused by an excess amount of bile pigment known as bilirubin in the body. Normally, bilirubin is formed by the breakdown of haemoglobin during the destruction of worn-out red blood cells.

Communicable Disease- Leptospirosis:

• Leptospirosis is a disease caused by a type of bacteria and is associated with animals. It is more common in the tropical countries.
• The disease is also known as canefield fever; cani- cola fever, field-fever, mud fever, seven day fever and swineherd disease. Leptospirosis is caused by different strains of bacteria of the genus Leptospira.
• Of all the varieties that cause disease, Leptospira icterohaemorrhagiae is the most serious type.
• If not treated properly, it could lead to serious complications. Leptospirosis is a disease of animals that can spread to humans.
• Rats are the most common carriers. Soil contaminated with urine of infected animals can also transmit the disease to persons exposed to cattle urine, rat urine or to foetal fluids from cattle.
• Sewage workers, agricultural workers, butchers, meat inspectors, workers in contact with contaminated waters and veterinarians are generally at risk.

• Person to person transmission is not possible. Leptospirosis can spread due to con­tact with urine, blood or tissues from infected persons. The organisms enter the body through the breaks in the skin or through mucous membranes.
• The organisms can also be acquired by drinking contaminated water. Infection is commonly acquired by bath­ing in contaminated water.
• The organisms multiply in the blood and tissues of the body. Though the organism can affect any organ of the body, the kidney and liver are com­monly involved. The incubation period is usually 10 days. It may vary from 2 to 20 days.

Communicable Disease- Diarrhoeal Diseases:

• The term gastroenteritis’ is most frequently used to describe acute diarrhoea. Diarrhoea is defined as the passage of loose, liquid or watery stools.
• These liquid stools are usually passed more than three times a day. The attack usually lasts for about 3 to 7 days, but may also last up to 10 to 14 days.
• Diarrhoea is a major public health problem in developing countries. Diarrhoeal dis­eases cause a heavy economic burden on health services.
• About 15 percent of all pediatric beds in India are occupied by admissions due to gastroenteritis.
• In India, diarrhoeal dis­eases are a major public health problem among children under the age of 5 years. In health institutions, up to a third of total pediatric admissions are due to diarrhoeal diseases.
• Diarrhoea related diseases are a significant cause of mortality in children less than five years of age. Incidence is highest in the age group of 6 to 11 months.
• The National Diarrhoeal Disease Control Programme has made a significant contribution in averting deaths among children less than five years of age.

Communicable Disease- Amoebiasis:

• Amoebiasis is an infection caused by a parasite ‘Entamoeba Histolytica. The intestinal disease varies from mild abdominal discomfort and diarrhoea to acute fulminating dys­entery.
• Extra intestinal amoebiasis includes involvement of the liver (liver abseess), lungs, brain, spleen, skin, etc.
• Amoebiasis is a common infection of the human gastroin­testinal tract. It has a worldwide distribution.
• It is a major health problem in the whole of China south-east and west Asia and Latin America, especially Mexico. It is generally agreed that amoebiasis affects about 15 percent of the Indian popula­tion. Amoebiasis has been reported throughout India.

Communicable Disease-  Cholera:

• Cholera is an acute diarrhoeal disease caused by V. Cholera (classical or El T). It is now commonly due to the El T or biotype.
• The majority of infections are mild or symptomatic. Epidemics of cholera are characteristically abrupt and often create an acute public health problem.
• They have a high potential to spread fast and cause deaths. The epidemic reaches a peak and subsides gradually as the ‘force of infection declines.
• Often, when time control measures are instituted, the epidemic has already reached its peak and is waning.

Communicable Disease- Brucellosis:

• Brucellosis is one of the major bacterial zoonoses, and in humans is also known as undulent fever, Malta fever or Mediterranean fever.
• It is occasionally transmitted to humans by direct or indirect contact with infected animals.
• The disease may last for several days, months or occasionally, even years.
• Brucellosis is both a severe human disease and a disease of animals with serious economic consequences. Brucellosis is a recognized pub­lic health hazard that is found the world over.
• It is endemic wherever cattle, pigs, goats and sheep are raised in large numbers. The important endemic areas for Brucellosis exist in Mediterranean zones, Europe, Central Asia, Mexico and South America. Animal Brucellosis has been reported from practically every state in India.
• However, no statisti­cal information is available about the extent of infection in humans in various parts of the country.
• The prevalence of human Brucellosis is difficult to estimate. Many cases remain undiagnosed either because they are not apparent, or because physicians in many countries are unfamiliar with the disease.

Communicable Disease- Hookworm Infection:

• Hookworm infection is defined as: ‘any infection caused by Ancylostoma or Necator’.
• They may occur as single or mixed infections in the same person through various fac­tors, which have to be prevented. Hookworm infection is widely prevalent in India.
• Necator americanus is predomi­nant in south India, and Ancylostoms duodenal in north India. Recently, another spe­cies, A. ceylanicum has been reported from a village near Calcutta.
• The heavily infected areas are found in Assam (tea gardens).
• West Bengal, Bihar, Orissa, Andhra Pradesh, Tamil Nadu, Kerala and Maharashtra. More than 200 million people are estimated to be infected in India.
• It is believed that 60 to 80 percent of the population of certain areas of West Bengal, Uttar Pradesh, Bihar, Orissa, Punjab, and the eastern coast of Tamil Nadu and Andhra Pradesh are infected with hookworms.

Communicable Disease- Influenza:

• Influenza is an acute respiratory tract infection caused by influenza virus of which there are three types—A, B and C.
• All known pandemics were caused by influenza A strains, due to various factors. Influenza is found all over the world.
• It occurs in all countries and affects millions of people. Outbreaks of influenza A occur virtually every year. Major epidemics occur at intervals of two to three years, and pandemics at intervals of about 10 to 15 years.
• The first pandemic during the present century occurred in 1918-19, which affected an esti­mated 500 million people and killed more than 20 million.
• In India alone, over six mil­lion people died during this pandemic. This pandemic was caused by what is now known as the swine influenza virus.
• Recent pandemics occurred in 1957-58 owing to the influ­enza A (H2N2) and in 1968 owing to the influenza A (H3N2).
• Outbreaks of influenza B also occur annually with epidemics occurring at intervals of407 years. Influenza brought on by the type C virus occurs sporadically as small outbreaks.
• The unique features of influenza epidemics are the suddenness with which they arise, and the speed and ease with which they spread.
• The short incubation period, a large number of subclinical cases, a high proportion of susceptible population, short duration of immunity, and an absence of cross-immunity, all contribute to its rapid spread.
• The fate of the virus during inter-epidemic periods is also known. Possible expla­nations include transmission of virus to extra-human reservoirs (pigs, horses, birds. etc.,) latent infection or continuous transfer from one human to another. This explains the occurrence of sporadic cases.

Communicable Disease- Filariasis:

• It is caused by a parasite, which belongs to the nematode family Filariasis. According to WHO reports, an estimated 751 million people are at ‘risk’ for infection, and 120 million have actually been infected.
• The public health problem of lymphatic filariasis is greatest in China, India and Indonesia. These three countries account for about two-thirds of the estimated world total of persons infected.

Filarial Problem in India:

• Filariasis is a major public health problem in India. There are an estimated six million attacks of acute filarial disease per year, and at least 45 million persons currently have one or more chronic filarial lesions.
• Heavily infected areas are found in Uttar Pradesh, Bihar, Andhra Pradesh, Orissa, Tamil Nadu, Kerala and Gujarat.
• The infection is acquired from a person who has filariasis. The maximum infectivity is when the organisms are circulating the blood.
• The largest number appears in the blood at night time, and retreats from the blood stream during the day. Their usual habitat is in the lymph nodes.
• The mosquito feeds on such a person and acquires the filarial parasite. The filarial organism is transmitted when the mosquito bites a person. The parasite is deposited near the site of puncture.
• It passes through the punctured skin or may penetrate the skin on its own and finally reach the lymphatic system. Filariasis affects all age groups.

Communicable Disease- Tuberculosis:

• Tuberculosis remains a worldwide public health problem, particularly in the Third World countries. Tuberculosis is India’s biggest public health problem. An estimated that 5, 00,000 deaths annually are reported due to this disease, while a similar number of persons get cured.
• The population in the Third World countries like India is exposed to tuberculo­sis. The disease, however, does not develop in everyone who is exposed. Poor nutrition, overcrowding, low socio-economic status, are more likely to develop the disease.
• The prevalence of people who are infected is about 30 percent of the population. The prevalence of infection is more common in the younger population.
• The vast majority of cases are to be found in rural and semi-urban areas, where more than 80 percent of the country’s population lives. In urban areas, tuberculosis is found more frequently in slum-dwellers and lower socio-economic groups than in well-off groups

Current Burden of Non-Communicable Diseases in India

• Non communicable diseases are the one which are of long duration and slow in progression. As per World health organization, NCDs account for total 53% of all deaths in India. Most of the burden is attributed by cardiovascular diseases (24%), followed by respiratory diseases (11%), other NCDs (10%) and Injuries (10%).
• According to a report presented by world economic forum and Harward School of public health, the prevalent NCDs in India are CVDs, chronic respiratory diseases, Diabetes, and cancer.
• Cancer is one the leading cause of death in India with 28 lac cases at a point of time and 10 lac new cases taking place very year. The burden of cancer is expected to rise in the country due to the effects of tobacco, demographic transitions and increase in the life expectancy.
• Diabetes is another leading NCD in the nation. Estimated total number of people suffering with diabetes is 40.9 million in India and by 2025 it is expected to increase up-to 69.9 million. Diabetes accounts for 1.09 lakh deaths in a year.
• Hypertension is a major risk factor for cardiovascular diseases. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. The cases of CVDs are expected to rise up to 741 lacs in 2015.
• Chronic obstructive pulmonary disease is responsible for high rate of mortality and morbidity across the world. In 2010, almost 24 million adults over the age of 40 in India had COPD. It is expected to increase to 32 million by 2020.
• The other conditions which contribute to the burden of non-communicable diseases are mental health conditions (schizophrenia, depression & bipolar disorder) and musculoskeletal disorders (Rheumatoid arthritis, osteoarthritis & gout).
• The non-communicable diseases are emerging due to the risk factors associated with it. The main risk factors which are associated with NCDs are tobacco use, harmful use of alcohol, lack of physical activity and poor diet.3Table 2&3 shows the risk factors(Behavioral & Metabolic respectively) associated with noncommunicable diseases and their prevalence.
• In addition to the above said risk factors for NCDs; Globalization and urbanization has also contributed to its burden. It has caused the nutritional transition in the country because of the availability of the commercial food. One another important factor causing the rise in NCDs is change in demographic profile of the country.
• A study conducted by Joy Kumar Chakma & Sanjay Gupta on“Lifestyle and Non-Communicable Diseases: A double edged sword for future India” showed that In India, 53% of the deaths in 2008 were due to NCDs (WHO). The cardiovascular diseases (CVDs) alone account for 24 percent of all deaths.
• The anticipated cumulative loss of national income due to NCDs mortality for India for 2006-2015 will be USD237 billion. By 2030, this productivity loss is expected to double. These major NCDs can be prevented through effective interventions by undertaking the lifestyle related modifiable risk factors.
• Total deaths (in thousands) caused by non-communicable diseases as per WHO (2008) estimates are 2967.6 and 2273.8 among males and females respectively. NCD deaths under the age of 60 years are 35.0% (Males) and 32.1% (Females).

Diseases related to heart

There are many types of heart disease that affect different parts of the organ and occur in different ways.

Congenital heart disease 

This is a general term for some deformities of the heart that have been present since birth. Examples include:

Septal defects: There is a hole between the two chambers of the heart.

Obstruction defects: The flow of blood through various chambers of the heart is partially or totally blocked.

Cyanotic heart disease: A defect in the heart causes a shortage of oxygen around the body.

Arrhythmia 

Arrhythmia is an irregular heartbeat.  There are several ways in which a heartbeat can lose its regular rhythm. These include:

• tachycardia, when the heart beats too fast
• bradycardia, when the heart beats too slowly
• premature ventricular contractions, or additional, abnormal beats
• fibrillation, when the heartbeat is irregular

Arrhythmias occur when the electrical impulses in the heart that coordinate the heartbeat do not work properly. These make the heart beat in a way it should not, whether that be too fast, too slowly, or too erratically.

Irregular heartbeats are common, and all people experience them. They feel like a fluttering or a racing heart. However, when they change too much or occur because of a damaged or weak heart, they need to be taken more seriously and treated.

Coronary artery disease

The coronary arteries supply the heart muscle with nutrients and oxygen by circulating blood.  Coronary arteries can become diseased or damaged, usually because of plaque deposits that contain cholesterol. Plaque buildup narrows the coronary arteries, and this causes the heart to receive less oxygen and nutrients.

Dilated cardiomyopathy 

The heart chambers become dilated as a result of heart muscle weakness and cannot pump blood properly. The most common reason is that not enough oxygen reaches the heart muscle, due to coronary artery disease. This usually affects the left ventricle.

Myocardial infarction 

This is also known as a heart attack, cardiac infarction, and coronary thrombosis. An interrupted blood flow damages or destroys part of the heart muscle. This is usually caused by a blood clot that develops in one of the coronary arteries and can also occur if an artery suddenly narrows or spasms.

Heart failure 

Also known as congestive heart failure, heart failure occurs when the heart does not pump blood around the body efficiently.  The left or right side of the heart might be affected. Rarely, both sides are. Coronary artery disease or high blood pressure can, over time, leave the heart too stiff or weak to fill and pump properly.

Hypertrophic cardiomyopathy 

This is a genetic disorder in which the wall of the left ventricle thickens, making it harder for blood to be pumped out of the heart. This is the leading cause of sudden death in athletes. A parent with hypertrophic cardiomyopathy has a 50 percent chance of passing the disorder on to their children.

Mitral regurgitation 

Also known as mitral valve regurgitation, mitral insufficiency, or mitral incompetence, this occurs when the mitral valve in the heart does not close tightly enough. This allows blood to flow back into the heart when it should leave. As a result, blood cannot move through the heart or the body efficiently.

Mitral valve prolapse

The valve between the left atrium and left ventricle does not fully close, it bulges upwards, or back into the atrium. In most people, the condition is not life-threatening, and no treatment is required. Some people, especially if the condition is marked by mitral regurgitation, may require treatment.

Pulmonary stenosis

It becomes hard for the heart to pump blood from the right ventricle into the pulmonary artery because the pulmonary valve is too tight. The right ventricle has to work harder to overcome the obstruction. An infant with severe stenosis can turn blue. Older children will generally have no symptoms.

Causes

Heart disease is caused by damage to all or part of the heart, damage to the coronary arteries, or a poor supply of nutrients and oxygen to the organ.  Some types of heart disease, such as hypertrophic cardiomyopathy, are genetic. These, alongside congenital heart defects, can occur before a person is born.

There are a number of lifestyle choices that can increase the risk of heart disease. These include:

• high blood pressure and cholesterol
• smoking
• overweight and obesity
• diabetes
• family history a diet of junk food
• age
• A history of preeclampsia during pregnancy
• staying in a stationary position for extended periods of time, such as sitting at work

Diseases related to kidney

Abderhalden-Kaufmann-Lignac syndrome

Autosomal recessive syndrome of disturbance of amino acid transport characterized by deposition of cystine crystals in numerous tissues of the body, particularly evident in the conjunctiva and cornea. Children in whom cystinosis is found are subnormal in development, with dwarfing, rickets, and osteoporosis. Renal tubular disease, aminoaciduria, glycosuria, and hypokalemia are usually present. Cystinosis occurs primarily in children; only two cases are believed to have been observed in adults. The syndrome has been described in siblings but not in different generations. It is of a simple Mendelian character.

Adenovirus Tubulointerstitial Nephritis 

Renal allograft involvement for Adenovirus infection is rare and can manifest as necrotizing tubulointerstitial nephritis and space-occupying lesion. The common differential diagnoses include BK and CMV mediated interstitial nephritis for the most part when viral inclusions are present. However, presence of severe necrotizing granulomatous lesions with predominant neutrophilic inflammation would be considered characteristic for Adenovirus.

Chyluria

Chyluria, also called chylous urine, is a medical condition involving the presence of chyle in the urine stream, which results in urine appearing milky white. The condition is usually classified as being either parasitic or non parasitic. It is a condition that is more prevalent among people of Africa and the Indian subcontinent.  Chyluria appearance is irregular and intermittent. It may last several days, weeks or even months. There are several factors that trigger Chyluria recurrence.

Diuresis

Diuresis is increased urination and the physiologic process that produces such an increase. It involves extra urine production in the kidneys as part of the body’s homeostatic maintenance of fluid balance.  In healthy people, the drinking of extra water produces mild diuresis to maintain the body water balance. Many people with health problems such as heart failure and kidney failure need diuretic medications to help their kidneys deal with the fluid overload of edema. These drugs help the body rid itself of extra water via the extra urine. The concentrations of electrolytes in the blood are closely linked to fluid balance, so any action or problem involving fluid intake or output (such as polydipsia, polyuria, diarrhea, heat exhaustion, starting or changing doses of diuretics, and others) can require management of electrolytes, whether through self-care in mild cases or with help from health professionals in moderate or severe cases.

Renal cortical necrosis

Renal cortical necrosis (RCN) is a rare cause of acute kidney failure. The condition is “usually caused by significantly diminished arterial perfusion of the kidneys due to spasms of the feeding arteries, microvascular injury, or disseminated intravascular coagulation” and is the pathological progression of acute tubular necrosis. It is frequently associated with obstetric catastrophes such as abruptio placentae and septic shock, and is three times more common in developing nations versus industrialized nations (2% versus 6% in causes of acute kidney failure).

Kidney stones

Kidney stones are another common kidney problem. They occur when minerals and other substances in the blood crystallize in the kidneys, forming solid masses (stones). Kidney stones usually come out of the body during urination. Passing kidney stones can be extremely painful, but they rarely cause significant problems.

Glomerulonephritis

Glomerulonephritis is an inflammation of the glomeruli. Glomeruli are extremely small structures inside the kidneys that filter the blood. Glomerulonephritis can be caused by infections, drugs, or congenital abnormalities (disorders that occur during or shortly after birth). It often gets better on its own.

Polycystic kidney disease

Polycystic kidney disease is a genetic disorder that causes numerous cysts (small sacs of fluid) to grow in the kidneys. These cysts can interfere with kidney function and cause kidney failure. (It’s important to note that individual kidney cysts are fairly common and almost always harmless. Polycystic kidney disease is a separate, more serious condition.)

Urinary tract infections

Urinary tract infections (UTIs) are bacterial infections of any part of the urinary system. Infections in the bladder and urethra are the most common. They are easily treatable and rarely lead to more health problems. However, if left untreated, these infections can spread to the kidneys and cause kidney failure.

Glycosuria

Glycosuria or glucosuria is the excretion of glucose into the urine. Ordinarily, urine contains no glucose because the kidneys are able to reabsorb all of the filtered glucose from the tubular fluid back into the bloodstream. Glycosuria is nearly always caused by elevated blood glucose levels, most commonly due to untreated diabetes mellitus. Rarely, glycosuria is due to an intrinsic problem with glucose reabsorption within the kidneys (such as Fanconi syndrome), producing a condition termed renal glycosuria. Glycosuria leads to excessive water loss into the urine with resultant dehydration, a process called osmotic diuresis.

Acute kidney injury

Acute kidney injury is sudden damage to the kidneys. In many cases it will be short term but in some people it may lead to long-term chronic kidney disease.  The main causes are:

• damage to the actual kidney tissue caused by a drug, severe infection or radioactive dye
• Obstruction to urine leaving the kidney (for example because of kidney stones or an enlarged prostate).

People who have chronic kidney disease are also at increased risk of acute kidney injury.

Chronic kidney disease

More often, kidney function worsens over a number of years. This is known as chronic kidney disease. Sometimes it can progress to end stage kidney disease, which requires dialysis or a kidney transplant to keep you alive.

There are different causes of chronic kidney disease, the key ones being:

• damaged blood vessels to the kidneys due to high blood pressure and diabetes
• attacks on the kidney tissue by disease or the immune system (glomerulonephritis)
• the growth of cysts on the kidneys (polycystic kidney disease)
• damage due to backward flow of urine into the kidneys (reflux nephropathy)
• congenital abnormalities of the kidney or urinary tract.

There are many other causes of kidney disease, and sometimes the cause is not known. Regardless of the cause of the disease, some parts of the treatment are common to all. However, your doctor will always attempt to find the cause of your kidney disease as it may have important implications.  If the cause of your kidney disease is genetic or unknown, your doctor may recommend your relatives also be checked.

Epidemic diseases

Complete information on major types of epidemics in India

• India is endemic to many diseases such as Malaria, Kala-azar, Cholera, Tuberculosis. These erupt in epidemic form when conditions are favorable for their spread.
• Epidemics are disasters by themselves but these can emerge in the aftermath of other disasters as well.
• In the recent past, two epidemics, viz., plague and dengue inflicted the Indian population very badly at Surat and Delhi, respectively. However, these occurred by themselves and were not the result of any other natural disaster.

The Surat (Gujarat) Plague Epidemic -1994

• Plague is a disease known to mankind from ancient times. India has undoubtedly a long history, which is replete with plague epidemics and havoc caused by them. This recent outbreak of plague generated a tremendous concern in and outside the country.
• No other disease so amenable to prevention and control has generated such serious concern in contemporary times. If its present epidemiological picture is appropriately examined, it does not deserve the attention it received.
• The reason for its larger than life size attention in the media in the country and outside, and the reason for the controversies which plagued this plague outbreak are possibly due to an inappropriate perception of the changing epidemiology of plague in modern era, when we have powerful management and diagnostic tools to contain the disease.
• This outbreak occurred in Surat on 1911 September, 1994.
• Following the sudden increase in the number of admitted cases with acute onset of fever, chest pain, cough, hemoptysis and deaths between 19th and 20th September, 1994 in different city hospitals, a sense of deep concern arose.
• As no history of rat fall could be elicited and typical bubonic cases were not seen, primary pneumonic plague outbreak was considered a possibility.
• The clinical presentation and the course of the disease pointed towards the pneumonic plague.
• Though stray cases were reported from other parts of the city, the major concentration of the reported cases came from the two adjacent localities of Ved Road and Katargam where the population were by and large Maharashtrians, the sanitation was very poor and the localities were highly congested slums.
• Furthermore, these areas are situated adjacent to river Tapti which was flooded between 7th and 9th September, 1994 due to heavy rains.
• About five lakh cusecs of water was released from the Ukai reservoir which led to the heavy water logging of the area.
• When the flood water started receding on 14th and 1511 September, 1994, the people of the localities started cleaning the areas and perhaps many of them handled dead wild rodents and animals.
• The Ganapati festival was observed with pomp and grandeur on 18fl1 September, 1994, when a large procession passed through the area and thereby getting infected probably.
• While the first patients were hospitalized on September 19, the panic was so great that by September 29, about 2 lakh persons (one-third of the population) had fled the city. During the period of the outbreak, 52 deaths were recorded from Surat city of which majority occurred before 25th September, 1994.
• A total of 1088 cases were suspected, about 146 were presumptive cases and 52 deaths due to plague took place during the period from 19th September, 1994 giving an overall case fatality rate of 4.8%.
• A study was carried out in Surat city during 8-19 November, 1994. Several identifiable risk factors were studied like occupation of the people, their visits outside Surat during the incubation period, exposure to a case, participation in the Ganapati procession festival, participation in cleaning operation, any associated illness, consumption of antibiotic, which could be accountable for the sporadic spread of the epidemic.
• The surprising thing was that the National Capital Delhi was also hit by the plague soon thereafter, although located faraway at about 1000 km. from Surat.

Control Measures

• Apart from identifying the patients and providing them proper medical treatment and care, a massive cleaning and sanitizing operation was conducted by the Municipal Corporation of Surat under the inspiring guidance of its Chief Executive whose efforts at cleaning up the city and thereby protecting it from epidemics were lauded nationally and internationally.

Dengue Epidemic in Delhi – 1996

• Dengue epidemic struck the Capital from mid-August to end-November, 1996, with Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), the worst ever in India’s history. The virus, viz., Type II Dengue was identified as the causative agent in a number of clinical sanipies.
• There were in all about 10,000 cases with nearly 400 deaths as reported from all parts of the city.
• The following reasons were identified for the dramatic emergence in India of Dengue/DHF as a major public health problem:

1. Ineffective Mosquito Control Programmes
2. Major demographic and social changes, the most important being uncontrolled urbanization, excessive population growth and urban decay characterised by substandard housing and inadequate water and waste disposal systems; and
3. Inadequate medical and health services.

• Dengue fever is caused by the bite of a mosquito known as Aedes Aegypti which profusely breeds in coolers, storage tanks, earthen pots and other receptacles with rainwater or stored clean water.
• There are a large number of other possible breeding places of Aedes Aegypti, viz., flower vases, neglected cups of jugs, household collection of water, neglected features of buildings, uncovered cisterns, wells, roof gutters, cracks in the masonry, traps of drains, flush tanks, ant traps, water receptacles of various kinds, rain filled empty cans or food tins, leaking water supply, water meters, sluice water chambers, water for birds, broken bottles, garden tanks, tree chambers, tree holes, fountains, troughs, a variety of dumps for engineering goods, trees, scraps and many more.

Control Measures

• Following the report of six deaths due to dengue at the All India Institute of Medical Sciences in The Times of India on September 13th 1996, the Municipal Corporation of Delhi (MCD) deputed two senior officers from the Antimalaria Department to collect the details.
• Containment measures were immediately taken in the localities from where these cases were reported.
• By September 14, 1996, the total number of cases admitted as DHF in Delhi was II.
• The MCD and the New Delhi Municipal Committee (NDMC) took the following measures:

1. House to house survey for detection of vector breeding sources
2. Intensification of anti-larval operation
3. Focal spray with pyrethrum extract
4. Intensification of health education Activities

• Public notice by way of newspapers to educate the people regarding dengue and to control the domestic breeding of mosquitoes was done.
• Likewise equipment like spray pumps, fogging machines were put in operation in large numbers.
• Control room for monitoring the situation and distribution of pyrethum solution to the NGOs was also taken-up.
• In the year 2001, dengue again seemed to appear in Delhi and a few cases were reported in October.
• Timely campaign against breeding of mosquitoes by public education and public health measures ensured that the disease did not attain epidemic status.

LESSONS LEARNT

Plague

1. The diseases of the past can make their resurgence if favorable environment conditions are present. Efforts to prevent the resurgence of such deadly diseases have to be made by way of good sanitary conditions, hygiene and cleanliness.
2. The decaying material including dead animals in the unsanitary conditions that usually prevails after the occurrence of destructive natural disaster situations such as earthquakes result in the spread of diseases/ epidemics as was seen in the case of the Latur earthquake of 1993.
3. People living in poor sanitary conditions, congested slums and overcrowded localities are more prone to communicable diseases like plague.
4. Migratory population and people participating in crowded functions during festivals and processions create conditions conducive for the spread of such diseases.
5. Surveillance and monitoring programme for the diseases like plague are lacking at present. For want of required data/information on various causative factors, these epidemics cannot be forecast, thus further deterring timely preventive measures.
6. Public needs to be educated about the signs and symptoms of likely diseases so as to enable the early detection and preventive measures of such diseases.

Local health authorities have to keep a constant vigil on the epidemic prone areas.

Dengue Fever

1. The outbreaks of dengue including dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS) can be anticipated through a system of surveillance and monitoring of Vector densities.
2. A check on the spread of epidemics by means of adequate control and monitoring measures before and after the occurrence of epidemics has to be ensured.
3. Breeding conditions and the vector around Delhi and in other parts of the country pose a constant threat of dengue in India. Desert coolers, water storage tanks and utensils, leaking water supplies, wells and fountains, rain water collections and water bodies, tyre dumps, junk cans, rain-soaked and uncleared garbage dumps, etc. provide excellent places for Aedes breeding.
4. DHF has become endemic and would surface periodically because of the very high vector breeding. The only practical approach to avoid future epidemics lies in preventive vector control with main reliance on source reduction and sanitation.
5. Extensive training programme to update their knowledge and skills in this area is essential for health workers.
6. We must accept and face the reality that dengue can surface again and to prevent future outbreaks, especially in the absence of any specific antiviral treatment or vaccine, sustained preventive community measures is the only key to success. Public education in this regard is very essential.

Tuberculosis Programme

• TB was declared as a global health emergency in 1993. In the same year, India established the RNTCP as a small pilot project. This project was scaled up nationwide between 1998–2006.
• The overall vision of RNTCP is “A TB free India”—a situation in which TB is no longer a major public health problem.
• Over the last 15 years, the RNTCP became one of India’s largest and greatest public health achievements.
• By 2006, decentralized basic TB control services had been established nationwide. In 2006–11, in its second phase RNTCP sought to improve the quality and reach of services, and reach global case detection and cure targets.
• These targets were achieved by 2007-08, and from 2006–10 alone more than 27 million chest symptomatic have been examined and 6 million treated.
• In the process, the programme implemented activities effectively, delivering Rs. 1545 crores (as of March 2012) expenditure against Rs.1447 crores planned expenditure in the 11th five year plan. There is compelling evidence that the tide has turned for TB.
• The burden of TB has begun to fall, and there are now fewer TB-related deaths each year than the year before.
• Despite these achievements, undiagnosed and mistreated cases continue to drive the epidemic such that TB remains an enormous public health problem for India. In 2011 alone an estimated 1.2 million TB cases occurred, and 60,000 people died of TB – nearly 165 deaths per day. Nearly 1 in 6 deaths among adults aged 15–49 are due to TB. More adult women die of TB every year than from peri-partum complications or HIV/AIDS. TB remains the leading cause of illness and death among persons living with HIV/AIDS. Nearly 100,000 cases of serious multidrug resistant TB (MDR-TB) are estimated to occur in the country every year, mostly attributable to prior inadequate treatment, and each MDR TB case costs more than Rs 1 lakh to diagnose and treat. TB affects anyone, but predominantly the poor and marginalized, perpetuating poverty through health and economic shocks to families least able to cope.

History of TB Control:

• Despite the National TB Programme (NTP) being in existence since 1962, no appreciable change in the epidemiological situation of TB in the country had been observed. The HIV-AIDS epidemic and the spread of multi-drug resistance TB were threatening to further worsen the situation. In view of this, in 1992, GOI, with WHO and SIDA reviewed the TB situation and identified the following limitations:
• NTP, was managerially weak
• Inadequate funding for program activities
• Over-reliance on x-ray for diagnosis
• Frequently interrupted drug supply
• Low rates of treatment compliance
• In order to overcome these limitations, in 1993 the GoI decided to reenergize the NTP, with assistance from international agencies.

The Revised National TB Control Programme

• The Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, as the most systematic and cost-effective approach for TB control in India. Political and administrative commitment, to ensure the provision of organised and comprehensive TB control services was obtained. Adoption of smear microscopy for reliable and early diagnosis was introduced in the general health services. DOTS was adopted as a strategy for provision of treatment to increase the treatment completion rates.
• The supply of drugs was also strengthened to meet the requirements of the system.
• The key objectives of the RNTCP were to achieve and maintain at least 85 per cent cure rate among the new smear-positive cases initiated on treatment, and thereafter a case detection rate of at least 70 per cent of such cases

RNTCP (Revised National TB Control Programme Growth) & Innovations:

• The RNTCP built on the infrastructure and systems built through the NTP. A key focus area was strengthening the recording and reporting systems.
• An addition to the RNTCP was the establishment of a subdistrict supervisory unit, known as a TU (Tuberculosis Unit), with dedicated RNTCP supervisors. This led to decentralization of both diagnostic and treatment services, with treatment given under the support of DOT providers.
• The quality of diagnosis of TB patients under RNTCP improved by giving the highest priority to the provision of quality assured sputum smear microscopy services.
• Another key innovation under RNTCP has been the development of Patient-Wise Boxes, which contain the full course of treatment for an individual patient.
• This ensures that treatment of that patient cannot be interrupted due to a lack of drugs. The RNTCP has effectively decentralized supervision via the sub-district TB Units, with in-built systems for monitoring and evaluation.

RNTCP (The Revised National TB Control Programme) II

• RNTCP II was developed based on the lessons learnt from the implementation of the programme over a 12-year period (1993-2005).
• RNTCP II was designed to consolidate the gains achieved in RNTCP I and to initiate services to address TB/HIV, MDR-TB and extend RNTCP to private sector.
• Systematic research and evidence building to inform the programme for better design was also an important component of the programme. The emerging needs of Advocacy, Communication and Social Mobilization were addressed in the new phase.
• The challenges imposed by the structures under NRHM were also taken into account for RNTCP II.
• Since 2007, the programme has been consistently achieving a treatment success rate of >85% and a NSP case detection rate (CDR) of >70%.
• In 2011, RNTCP achieved the NSP CDR of 72% and treatment success rate of 88%, which is in line with the global targets for TB control.

Monitoring, supervision and evaluation:

• The RNTCP’s ‘Supervision and Monitoring strategy’ includes detailed guidelines, tools and indicators for monitoring the performance from the PHI level to the national level.
• The quality programme implementation is ensured by frequent Internal and external evaluations.
• The programme is focusing on the reduction in the default rates among all new and re-treatment cases.
• Quality assured sputum smear microscopy facilities are available nationwide through about 13,000 sputum microscopy laboratories in the health system.
• As a result, chest symptomatic examined has increased from 397 to 642 per 100,000 population per annum over the last 10 years.
• Quality assured anti-TB drugs for the full course of treatment are provided to the patients through patient wise boxes.
• Decentralized treatment is provided through a network of more than 6,40,000 DOTS providers, to provide treatment to the patients as near to their home as possible

National Strategic Plan 2012-17/ The National Strategic Plan for TB Control 2012-17 (NSP-RNTCP)

• The vision of the Government of India is for a “TB-free India” with reduction of the burden of the disease until it is no longer a major public health problem.
• To achieve this vision, the programme has now adopted the new objective of Universal Access for quality diagnosis and treatment for all TB patients in the community.
• This entails sustaining the achievements of the programme to date, and extending the reach and quality of services to all persons diagnosed with TB.
• With the GOI vision as a long term guide, the programme defined objectives for 2012–2017 are:

1. To ensure early and improved diagnosis of all TB patients including drug resistant and HIV-associated TB
2. To provide access to high-quality treatment for all diagnosed cases of TB
3. To scale-up access to effective treatment for drug-resistant TB
4. To decrease the morbidity and mortality of HIV-associated TB
5. To extend RNTCP services to patients diagnosed and treated in the private sector.

Thrust areas and Strategies

• Strengthening and improving the quality of basic DOTS services
• Further strengthening and aligning with health system under NRHM
• Deploying improved rapid diagnostics to the field level
• Expanding efforts to engage all care providers
• Strengthening urban TB Control
• Expanding diagnosis and treatment of drug resistant TB
• Improving communication, outreach, and social mobilization
• Promoting research for development and implementation of improved tools and strategies

Vector borne diseases

Main vectors and diseases they transmit

• Vectors are living organisms that can transmit infectious diseases between humans or from animals to humans.
• Many of these vectors are bloodsucking insects, which ingest disease-producing microorganisms during a blood meal from an infected host (human or animal) and later inject it into a new host during their subsequent blood meal.
• Mosquitoes are the best known disease vector.
• Others include ticks, flies, sandflies, fleas, triatomine bugs and some freshwater aquatic snails.

Mosquitoes

1. Aedes
2. Chikungunya
3. Dengue fever
4. Lymphatic filariasis
5. Rift Valley fever
6. Yellow fever
7. Zika
8. Anopheles
9. Malaria
10. Lymphatic filariasis
11. Culex
12. Japanese encephalitis
13. Lymphatic filariasis
14. West Nile fever

Sandflies

1. Leishmaniasis
2. Sandfly fever (phelebotomus fever)

Ticks

1. Crimean-Congo haemorrhagic fever
2. Lyme disease
3. Relapsing fever (borreliosis)
4. Rickettsial diseases (spotted fever and Q fever)
5. Tick-borne encephalitis
6. Tularaemia

Triatomine bugs

1. Chagas disease (American trypanosomiasis)

Tsetse flies

1. Sleeping sickness (African trypanosomiasis)

Fleas

1. Plague (transmitted by fleas from rats to humans)
2. Rickettsiosis

Black flies

1. Onchocerciasis (river blindness)

Aquatic snails

1. Schistosomiasis (bilharziasis)

Lice

1. Typhus and louse-borne relapsing fever

Vector-borne diseases

• Vector-borne diseases are human illnesses caused by parasites, viruses and bacteria that are transmitted by mosquitoes, sandflies, triatomine bugs, blackflies, ticks, tsetse flies, mites, snails and lice.
• Every year there are more than 700 000 deaths from diseases such as malaria, dengue, schistosomiasis, human African trypanosomiasis, leishmaniasis, Chagas disease, yellow fever, Japanese encephalitis and onchocerciasis, globally.
• The major vector-borne diseases, together, account for aeround 17% of all infectious diseases.
• The burden of these diseases is highest in tropical and subtropical areas and they disproportionately affect the poorest populations.
• Since 2014, major outbreaks of dengue, malaria, chikungunya yellow fever and Zika have afflicted populations, claimed lives and overwhelmed health systems in many countries.
• Distribution of vector-borne diseases is determined by complex demographic, environmental and social factors.
• Global travel and trade, unplanned urbanization and environmental challenges such as climate change can impact on pathogen transmission, making transmission season longer or more intense or causing diseases to emerge in countries where they were previously unknown.
• Changes in agricultural practices due to variation in temperature and rainfall can affect the transmission of vector-borne diseases.
• The growth of urban slums, lacking reliable piped water or adequate solid waste management, can render large populations in towns and cities at risk of viral diseases spread by mosquitoes.
• Together, such factors influence the reach of vector populations and the transmission patterns of disease-causing pathogens.

Vector Borne Diseases in India

• There are many vector-borne diseases prevalent in India like malaria, filariasis, Kyasanur forest disease, Japanese encephalitis, scrub typhus, dengue and chikungunya.
• The control of all of them depends on an understanding of the natural cycles and epidemiology of their vectors.

Malaria

• Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected Female anopheles mosquito. In the human body, the parasites multiply in the liver, and then infect red blood cells.
• Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.

Dengue

• Dengue fever, also known as breakbone fever, is a mosquito-borne tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles.
• Dengue is transmitted by several species of mosquito within the genus Aedes, principally  aegypti.

Japanese Encephalitis (JE)

• JE is mostly present in in Southern India, Uttar Pradesh, North Eastern states, Haryana. Its causative agent  is Group B arbovirus (Flavivirus) & it is transmitted by Culex mosquitoes.

Chikungunya

• Chikungunya is a viral disease transmitted to humans by infected mosquitoes. It causes fever and severe joint pain.
• Other symptoms include muscle pain, headache, nausea, fatigue and rash.Joint pain is often debilitating and can vary in duration.
• The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common.

Filaria

• Filariasis  is a parasitic disease caused by an infection with roundworms of the Filarioidea type.
• These are spread by blood-feeding black flies and mosquitoes. This disease belongs to the group of diseases called helminthiasis.

Kala-Azar

• Visceral leishmaniasis also known as kala-azar, black fever is the most severe form of leishmaniasis.
• Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus. This disease is the second-largest parasitic killer in the world after malaria.

Kyasanur forest disease

• The Kyasanur forest disease, transmitted by ticks, and scrub typhus, transmitted by mites, are re-emerging in India.
• Birds and animals, both small and large and wild and domestic, are also involved in the transmission.