Infections

-Causes: commonly batceria (E.coli from GI tract) in bladderrethra
-Risk factors: females, sexual activity, pregnancy, post-menopausal, diabetes

-Increased urgency, burning in urination (dysuria), lower abdominal discomfort, pelvicack pain, cloudy or bloody urine, strong smelling urine, sometimes fever

-Nitrofurantoin 100mg (MR) BD for 3 days
OR
-Trimethoprim (if low chance of resistance)
-2nd line include pivemecllinam or fosfomycin

Strep. pneumoniae & spread via air droplets or skin contact

Oral antibiotics (home, mild), e.g. amoxicillin

PPV (Pneumococcal polysaccharide vaccine)

-Campylobacter
-Salmonella
-E.coli
-Shigella

As it is self limiting:
-staying hydrated
-In severe cases AB needed

A type of bacteria that infects the stomach
-Can be colonized without disease

GI tract ulcers & gastric cancer

-H. pylori can cause damage to the stomach & epithelial lining
-This can cause gastritis (inflammation) --> ulcers
-can later lead to gastric cancer

-Abdominal pain
-Nausea
-Bloating
-Bleching

PPI (lansoprazole, omprazole etc) * 2 ABs--> Amoxicillin & EITHER clarithromycin OR metrondizole for 7 days

-Usually bacterial & in those with heart valve replacement or damage

S. aureus or Strep

Fever, chills,
heart murmurs, tiredness/fatigue, cough,
headache, shortness of breath, night sweats

Depends on number of factors.
- e.g. a penicillin (+gentamicin, Strep) or flucloxacillin (Staph).
-If serious, empiric treatment: e.g. ampicillin (or vancomycin, MRSA)/flucloxacillinentamicin
All for 2-6 weeks

Overgrowth of bad anaerboic bacteria in the vagina

- white/pale grey, milky, fishy-smelling
- thin , smooth, milky or creamy consistency
- does not tend to itch

Oral or topical metronidazole 400mg 5-7d

BV:
-white/pale grey VS white colour
-thin, smooth, milky/creamy VS curd like consistency
-Fishy vs no bad smell
-NO Burning/itching VS pain & irritation during urination/intercourse

generates nitro radicals w/in bacteria that damages DNA
- contains imidazole ring
-Reduction occurs moreso in anaerobes

-Break in the epidermis (skin)
-Infection with Staph. aureus OR strept pyogenes
-Caused by containt with infectious indivduals/organisms (CONTAGIOUS)

Good hygeine

-Topical hydrogen peroxide 1% cream.
-If not suitable; topical fusidic acid
- If resistant, topical mupirocin 2% ointment

-For beta-lactamase producing Staph-->Oral flucloxacillin 500mg QDS
-Allergy -->clarithromycin
-In pregnancy --> erythromycin

- Inflammation of dermis & subcutaneous tissue
-S.pyogenes OR S. aureus are main causes

Flucloxacillin 500mg QDS for 7 days
- Clarithromycin, doxycycline or erythromycin are alternatives in mild cases with penicillin allergy

S. aureus, H. influenzae, S. pneumoniae
-produces thick & yellow discharge, itchyritty eye, pinked

1st: self-care (bath/clean)
2nd: topical ABs--> chloramphenicol 0.5% drops or ointment

Viral has more of a waterier discharge & BC is more yellow and thick

Cause: mainly bacterial--> P. aeruginos, S. aureus BUT can be fungal
-Symptoms: pain, itchiness, discharge, hearing loss

1st line: pain relief & local heat
- 2nd line: topical treatment: topical acetic acid, corticosteroids (bethamethasone) and/or topical Abx e.g. neomycin

Cause: usually viral; can be bacterial--> S. pneumoniae/H. influenzae
-Symptoms: earache, high temp, vomiting, fatigue, slight hearing loss

-Often sel-limiting
-Pain relief
-if severe --> ABs e.g. amoxcillin

-Often viral; can be bacterial
-Symptoms include inflamed throat (pharyngitis) & inflamed tonsils (tonsilitis)

Often self limiting
-For GAS--> phenoxymethylpenicillin
-Can use paracetamol, gargling & fluids

Group A streptococci are bacteria commonly found in the throat and on the skin.

-often caused by S. aureus & Strep.

The joint & bone marrow (respectively)

Flucloxacillin (4-6 weeks)

Flucloxacillin (6 weeks) & can use adjunctly with fusidic acidifampicin (for 1st two weeks)

-strep. pneumoniae
-Neisseria meningitidis (meningcoccal)
-H.influenzae B (young)

Fever, headache, and stiff neck, nausea
convulsions & non-blanching rash, photophobia

-Benzylpenicillin (if meningococcalash, parenteral)
-In hospital IV e.g. ceftriaxone/cefotaxime
-Corticosteroids e.g. dexamethasone is used

HiB, PCV, MenB, MenC, MenACWY

-Inflammatory immune response to infection --> tissue damage & organ failure
- Often bacterial (Gram+ Staph, Gram- E.coli BUT can be fungal/viral

-Fever
-Low body temp
-High HR & breathing
-confusion
-Low BP
-low urine output
-Non-blanching rash

-Severe: confusion, low BP

ABx , IV fluids & O2 as needed

Bacteria: Examples include - S. aureus, S. pyogenes P. aeruginosa.
Type I - disrupt host cell without entry (endotoxins
Type II - destroy host cell membranes to invade and interrupt host defense;
Type III - disrupt host defense to allow dissemination of infection

-Program to change & direct AM use at a healthcare instiution
OR
-an organisational or healthcare-system-wide approach to promote & monitor optimal use AMs to preserve their future effectiveness

-Critical: enterobacteriacae (carbapenem-resistant, 3rd gen. cephalosporin-resistant)
-High: Staphyloccous aureus (methicillin-resistant, vancomycin inter & resistant)

-Reduce need for unintentional exposure to AMs
-Optimise use of AMs
-invest in innovation, supply & access

-Halve healthcare (HC) associated Gram-negative blood stream infections
-Reduce NO. of specific drug-resistant infection in people by 10% by 2025
-Reduce UK AM use in humans by 15% by 2024

-Access: promoting access to preferred treatment
-Watch: specific, limited indications & usage for "highest-priority critically important AMs"
-Reserve: use Abx as a last resort

Commissioning for Quality & Innovation (CQUIN) framework supports improvements in quality of services & creation of new, improved patterns of care
- sets targets for CCGs and Prescribed specialist services (PSS)

-Redcution in AMx use
-Decrease inappropriate AMx use
-Improve susceptibility profiles of hospital pathogens
-Improve clincal markers (decreased length of stay, mortality)
-Increase appropriate AMx use (selection, dosing, route, duration)

-TARGET (primary)
-Start Smart then Focus (secondary): dont start ABx unless necessary

-Pro: direct control over AMx use --> appropriate therapy, cost effective
-Con: loss of autonomy for prescribers, need for AMS team access/device (if approval needed), time consuming

Pros: avoids loss autonomy of prescribers, education oppurtunities, reduce unwanted prescribing, flexible
Cons: compliance with recommendations is optional, workload of pharmacist, reactiver rather than proactive

Change from broad spectrum therapy --> specific patient tailored therapy

Pros: avoids LT use of broad spectrum agents, patient tailored, reduces resistance risk, secondary infection, use of safer AMx
Cons: pharmacist workload, sample processing time, testing required

-Pros: avoids entry site infections, cost savings, discharged earlier
-Cons: compliance

scheduled rotation of AMx used

Pros: may decrease resistance through change in selective pressure
Cons: adherence/ compliance concerns, effectiveness? lack of evidence, allergy/toxicity can result in use of specific drugs

Antimicrobial Order Forms:
e.g reduce AMx usage in practice --> Automatic stop orders

Healthcare assoicated infection
- nosocomial infections (acquired in a healthcare setting)
-e.g. surgical site infection, UTIs (and other catheter-related infection), pneumonia (including ventilator-related) etc

Bacteria
viruses
parasites

-Fecal-oral transmission --> acquisition
-spores spread infection are are dificult to contain

-can increase to>20% in hospital/nursing home inpatients
-Increase with Abx exposure especially broad spectrum ABs
-Increased mortality

-diarrhoea (can be severe)
-cramping to severe pain
-If severe, pseudomembranes, adherent yellowish-white plaques on the intestinal mucosa
-Rare: fulminant life-threatening colitis
-Fever, low grade to severe
Dehydration

•Nasogastric tube
•Anti-ulcer medication (PPI)
•Long duration of hospital stay
•Long duration of antimicrobial therapy
•Courses of multiple antimicrobials

•Clindamycin
•2nd and 3rd Generation cephalosporins
•Penicillins
•Aminoglycosides, fluoroquinolones

-main toxins are Toxin A and Toxin B (encoded by TcdA and TcdB genes).
- Binary toxin (CDT)

•Cytotoxic assay and toxigenic culture
•ELISA/EIA for toxins A/B presence of C. difficile toxins in stool*
•ELISA/EIA for GDH
•PCR/NAAT for toxin genes
- TcdA, TcdB and can include binary

-Stopping the offending antibiotic (if possible)
-Continuing therapy associated with refractory disease
-Symptomatic treatment
•Fluid & electrolyte replacement
•But not anti-diarrhoeals

1st: Oral vancomycin 125mg QDS
Alternative: recommended in certain cases and in combination with vancomycin, 500mg three times a day IV 10 days

-vancomyic: a glycopeptide that causes cell wall synthesis inhibition
-Metronidazole: a nitroimidazole that causes DNA damage/free radicals

-Fidaxomicin
-A macrocyclic that binds to RNA polymerase hence causing RNA synthesis inhibition

Enteral immunoglobulin (limited evidence), monoclonal antibodies against toxins e.g. bezlotoxumab

relpase: fidaxomicin
Recurrence: vancomycin or fidaxomicin

-Hand washing (not with alcohol rubs)
-Cohorting/isolation of patients
-Barrier nursing / PPE
-Increased surveillance
-Improved control of antimicrobial use
(AMS)

aka clostridiodes difficile
-A Gram positive, anaerobic, spore-forming rod.
-cause of antibiotic-associated diarrhoea (AAD) and colitis

Cause: chlaymydia trachomatis, gram negative
-Intracellular infection; obligate intracellular pathogen
-Attaches & invades epithelial cell --> reticulate body--> transformation to EB (elementary body)--> cell lysis & EB release

- often asymptomatic
-Painurning on urination & discharge

1st: doxycycline for 7 days
2nd (if contraindicated e.g. in pregnancy): azithromycin or erythromycin

-Increase risk of HIV
-Women can develop PIV and infertility

-Small bacterium with no cell wall
-Typically a co-infection

-Often asymptomatic in men and women
-pain in discharge and dysuria
-Urethrtis (Men)
Painful inter-menustral bleeding, lower abdominal pain (women)

-Pelvic inflammatory disease, reactive arthritis, premature birth, miscarriage

1st line: doxycycline then azithromycin
Alternative: Moxifloxacin

- Neisseria gonorrhoeae; gram neg diplococi
-spread via vaginal, anal, oral sex & from mother to baby

dysuria, watery yellowreen vaginal discharge & white/yellowreen penile discharge
-abdomen pain after intercourse
-penile urethral infection --> 90% symptoms in men

1st line: IM ceftriaxone

pelvic inflammatory disease, infertility, neonatal infections

GRASP: gonococcal resistance to antimicrobials surveillance programme
- Surveillance of AMR & susceptibilities of infections across the UK

-Infection in upper part of female reproductive system e.g. ovaries, fallopian tubes
-Bacteria from vagina/cervix spread to pelvis often gonorrhea, chlamydia

-STIs
-Multiple sexual partners
BV can increase risk

-Lower abdominal pain
-Fever
-vaginal discharge
dysuria
irregular bleeding in mensutration

-Scarring --> infertility
-ectopic pregnancy
-chronic pelvic pain

-Ceftriaxone IM (single dose), doxycycline oral for 14 days & metronidazole orally for 14 days

- Sores
-Rash
-Hair loss
-Flu-like symptoms
-Paralysis
-Blindness

Early: 1st line --> benzathine benzylpenicillin (SINGLE dose)
Late: 1st line --> benzathine benzylpenillin ( once a week for 3 weeks)
-administer IM

-TCA (tricholoroacetic acid) & podophyllotxin used on soft warts
-excision, cryotherapy, imiquimod cream

-Gardasil vaccine

-Pre-malignant tumors --> cancer

Herpes Simplex Virus (HSV)

-blisters
-Sores
-Painful/itchy
-Dysuria

- Saline
-analgesia
-topical anaesthetics

Oral antivirals
-aciclovir
-Valaciclovir

-flu-like illness
-Weight loss, diarrhoea, night sweats, infections

-Rash
-flu like symptoms
-right upper abdominal pain
-Nausea
-Dark urine
-Light stools & vomiting

Analgesics
Anti-emetic drugs

blood and body fluids --> sharing of IV needles and can be STI

To cure
-Direct acting antiviral (DAAs) e.g. paritaprevir , sofosbuvir

Women: yellowreen vaginal discharge, fishy smell, soreness, dysuria,
Men: white discharge dysuria, sorenessedness

Metronidazole

1% permethrin cream or 0.5% aqueous soln

1. Genetic material
2.Mode of replication
3.Structure & symmetry of capsid
4.Presence/absence of envelope

Replicates in host nucleus vs in cytoplasm
Often not incorporated into host genome vs reproduction dependant on sense/antisesne RNA

-Nucleoside/-tide reverse transcriptase inhibitors (NRTIs/NtRTIs))
-Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
-Protease inhibitors
-Integrase inhibitors

-Attachment/entry/fusion inhibitors: prevents fusion of virus with host cell
-Uncoating inh: prevents capsid from uncoating
-Nucleic acid synthesis inh:
-Intergrase inh
-Protease inh: used to assemble new virions
-Release inh

Lack 3' OH (prime hydroxyl) for further chain growth- INHIBITION viral DNA polymerase leading to chain termination

-Caused often by rhinoviruses
-Transmission --> airborne droplets

T: droplets
P: good hygeine, PPE, physical distancing measures

-corticosteroids-->Dexamethasone (or hydrocortisone or prednisolone)
-Monoclonal ABs; used as anti-inflammatory and neutralising therapy
-Anti-virals: e.g remdesivir (IV), Molnupiravir (oral)
-Baricitinib, low MWt heparin
-Paracetamol/ibuprofen

Types: 3 - A, B and C (and many subtypes)
A found in humans and animals, B/C only humans

-Secondary chest infection → pneumonia (elderly)
-Bronchitis, ear infections, sinus infections
-Worsen underlying condition

-Haemaglutinin (H) & neuraminidase (N)

-chest infection --> pneumonia
-Bronchitis, ear infections, sinus infections

At risk patients --> Zanamivir or oseltamivir. if no risk --> analgesia/antipyretics

fecal-oral route

-Often result of gastroenteritis
-Spread via fecal-oral (and contaminated surfaces)

-Self limiting
-Re-hydration
-Rotarix vaccine available for babies

-Diarrhoea
-Vomitting
-Stomach/abdominal pain
-Nausea
-Fever (RV)

S: fever, nausea, diarrhoea, fatihue
D: increased ALT levels

-rest, avoid fatty food & alcohol
-Vaccine --> avaxim (not permanent)

-Primary infection cause --> chicken pox (Varicella)
Transmisison: airborne particle inhalation OR direct contact lesions

-rash; red spots --> blister--> scab
-Fever, fatigue

encephalitis (inflammation of the brain, caused by infection), pneumonia, infection in lesions

-Calamine lotion
-Paracetamol
-Oral aciclovir (severe)

Antivirals e.g. aciclovir
Vaccines: Zostavax

-Contagious; spread via aerosols/droplets

Cause: human papillomavirus (HPV,L10)
-Contagious: objects, skin etc

Keratolysis (OTC)
-topical salicyclic acid, AgNO3, formaldehyde
-Cryosurgery; liquid N2

-cause: lentivirus (a retrovirus). Group V1 ssRNA-RT
-Infects immune cells --> CD4+ T cells, macrophage & dendritic cells
-Low CD4+ cells --> loss of cell-mediated immunity

1. Binding of virus to CD4 receptor & fuses with host cell membrane
2.Uncoated virus & viral RNA & other proteins enter host cell
3.Viral DNA is transcribed by reverse transcriptase
4.Viral DNA enters nucleus via viral integrase
5.New viral RNA is transcribed --> new viral proteins
6. Viral RNA & proteins assemble at the membrane
7. Budding-->mature viral particle released

ELISA/EIA

-Seroconversion; acute infection
-Clinical latency; chronic infection, asymptomatic stage
-AIDS; low CD4 count & high viral count

acquired immunodeficiency syndrome
-If HIV is not controlled well, can develop AID--> infection, cancers and disorders

Decrease:
-Viral Load
-Transmission
-Progression & infection risk
Increase:
-CD4 count
-Life expectancy & QOL

1. entry/fusion inhibitors
2.Reverse transcriptase inhibitors:
-Nucleotide reverse transcriptase Inhibitors (NRTIs) cause DNA chain termination
-Non-nucleoside reverse transcriptase inhibitors (NNRTIs) : direct inhibition HIV reverse transcriptase
3.Protease inhibitors
4.Integrase inhibitors

highly active antiretroviral therapy

Combination therapy:
2 NRTIs & 1 non-nucleotide reverse transcriptase inhibitor OR 1 protease inh OR 1 integrase inhi

-Truvada is used by HIV negatitve people at high risk of HIV infection

Taken AFTER high risk exposure to HIV
-Aims to prevent person becoming HIV pos+
-Regimen can include: Truvada 1 tablet OD (emtricitabine + tenofovir, NRTIs) +
Raltegravir 400mg BD (integrase inhibitor) --> 1st line

Truvada: Tenofovir disoproxil fumarate + Emtricitabine

•either backbone + efavirenz or atazanavir

animal cells do not have a cell wall, this makes disruption of cell wall synthesis an appropriate target for antibacterial agents such as penicillin.

Polymer of disaccharide. NAG: N-acetylglycosamine (shorter, OH-H), NAM: N-acetylmuramic acid (longer, H/O-HC-CH3-C=O-OH). Linked by Polypeptide Cross Bridge

-TPase is a transpeptidase enzyme that catalyses cross linking reaction of cell wall
-Penicillin mimics D-Ala-D-Ala terminus --> competitively inhibits TPase

There is a free carboxylate which is usually ionised

The bicyclic system causes further strain on the b-lactam ring& the greater the strain the greater the actvity but also the instability of the molecule to other factors

1. Ring strain- acid catalysed ring opening relieves the strain by breaking open the more highly strained beta lactam ring --> carbonyl group of the lactam is more prone to nucleophilic attack
2. Amide side chain can involve itself in mechanism to open the lactam ring --> beta lactam ring is destroyed

-minimise neighbouring amide interaction in mechanism that opens the lactam chain --> increase stability
-Introducing an EWG can reduce nucleophilicty of the acyl chain --> less able to open the lactam ring

V is less acid sensitive (better acid stability)

some gram pos+ release beta lactamase into surrounding environment.
-Beta lactamase enzymes can hydrolyse the beta-lactam linkage --> ring opened penicillin(inactive)

'Steric shields' (bulkyl group)can block penicillin from fitting into the active site of beta-lactamase --> resistance to enzyme mediated hydrolysis

-can make penicillin inactive against the transpeptidase target enzyme

Via IV
-As it doesn't have an EWG in its side chian --> acid sensitive

-Pencicillin which are hydrolysed via beta lactamases can be co-administered with inhibitors of b-lactamases--> B-lactam cannot be hydrolysed
-Clavulanic acid is an e.g (irreversible inhibitor)

kept as 'reserve troops' & used if infection is resistant to broad spectrum penincillin as a result of the presence of a B-lactamase enzyme

-4 membered B-lactam ring fused to a 6-membered dihydrothiazine ring

2nd gen has additional steric bulk --> increased stability against B-lactamase enzyme --> broader spectrum of activity
-Improved metabolic stability

1.polyenes
2.Azoles-imidazoles, triazoles
3.Allylamines (& amorlfine)
4.Echinocandins
5.Flucytosine

R: used in oral candida & for life threatening systemic infections e.g. cryptococcal meningitis
S: broad fungicidal & often used for IV as poor oral BioA

R: oral and topical cream
S: Broad

bind ergosterol -->pores in Plasma Membrane --> leakage of cell --> cell death (lysis)--> fungicidial

I: miconazole, clotrimazole, ketoconazole
T:fluconazole, voriconazole

I: dermatophytes, candidiasis (vast)
T:Broad (More for invasive & life-threatening)

Inhibit synthesis of ergosterol biosynthesis -->
= prevents conversion of lanosterol (into ergosterol)
-Fungistatic

Inhibits squalene epoxidase --> prevents ergosterol synthesis
-Fungistatic/cidal

Mainly dermatophytes: nail, infections, ringworm

broad dermatophytes & yeast

inhibits delta 14 reductase & delta 7-8 isomerase --> interferes/inhibits ergosterol biosynthesis
-fungicidal

Type: lipopeptides
e.g. Caspofungin

Aspergillus and Candida (broad)

Inhibts beta-1-3 glucan (part of cell wall)
-fungicidial

Cryptococcus
Candida

inhibits DNA and RNA synthesis
-fungistatic

T: benzofuran
S: dermatophytes (limited)

Inhibits mitosis (cell division)--> halts growth
-fungistatic

Rash
nausea
vomiting

Candidiasis, typically caused by type C. albicans
-Cause: broad specrum ABs & immunodeficiency

Thick, cheesy, or curd-like discharge with a must, pain, itching & could bleed when removed

-Imidiazole: clotrimazole
-Triazole:flucanazole
-Polyenes: nyastatin

-topical imidazole creams
-Example: Clotrimazole* 1% or 2% cream 2-3 times per day or ketoconazole 2% 1-2 times per day

intravaginal cream or perssary OR oral fluconazole or itraconazole
-Preg adults (16+): intravaginal clotrimazole or miconazole

-Amorolfine topical lacquer 5% OR or offer oral antifungal e.g. itraconazole
-Terbinafine is an alternative

-red scaly patches
-nail discoloration & thickening nails
-Hair loss, scarring
-Itchy

head/scalp: griseofulvin or terbinafine

breathlessness, fatigue, cough

Voriconazole IV
bronchodilators and steroids if needed

Topical antifungal e.g. clotimazole.
Larger areas--> antifungal shampoo
if widespread--> oral antifungals

T: inhalation of spores
S: lung infections e.g. cough/flu

oral itraconazole
if severe --> amphotericin B

S; fever, fatigue, dry cough, headache, blurred vision, chest pain
T: amphotericin B & flucytosine IV & then oral fluconazole

1. altered drug metabolism
2.efflux pumps (MDR or CDR genes)
3.change in protein target
4.prevention of drug entry

endoparasite:inside of host to obtain nutrients
ectoparasite: outer surface to obtain nutrients from host.

endo: protozoa, helminths
ecto: lice, leeches, scabies, fleas

-parasitic protozoa "Plasmodium"
-4 main types: P. falciparum, P. vivax, P. ovale and P. malariae

For uncomplicated malaria:
-Fever, chills, headaches, sweating, nausea, vomiting, aches ,shivering, fever
-More severe malaria is an -cerebral malaria, organ/ metabolic damage

-RTS,S
-R21

(1)Doxycycline (POM)
(2)proguanil + atovaquone (Malarone) -
(3)Mefloquine (POM)
Pregnancy: proguanil, chloroquine, mefloquine

1st choice is chloroquine

1st line
- Artemether + lumefantrine (Riamet)
[or dihydroartemisinin (aka artenimol) + piperaquine]
OR
-Quinine + Doxycycline (or clindamycin) OR
Proguanil + atovaquone (Malarone),

Quinine + clindamycin

Transmission: faecal-oral
-Cause: Entamoeba histolytica
- Treatment:
-Metronidazole (1st line,
OR
Tinidazole followed by paromomycin/diloxanide furoate

- Cause: Toxoplasma gondii
Human exposure common (e.g. cat faeces or infected meat, unwashed fruit/vegetables)
-Often self-limiting
Most often pyrimethamine plus sulphadiazine
Alternative plus clindamycin, clarithromycin or azithromycin

-Transmission: spread from water (swimming lakes / pools)
Contaminated foods / surfaces
-Symptoms: diarrhoea, dehydration, weight loss, stomach cramps or pain, fever, nausea, vomiting

-Usually don't treat "normal" patients
Nitazoxanide: those at risk

-Parasitic worms: cestodes, nematodes & trematodes
Transmission:
•Poorly cooked meat (esp. pork, fish)
•Contaminated water
•Faeces
•Some by insects e.g. mosquito

•upper abdominal discomfort
•diarrhoea
•loss of appetite
•often asymptomatic
Treatment: Taenicides: niclosamide or praziquante

-Good hygiene: e.g. Scrub nails,
-•mebendazole (100mg)

praziquantel

-Permethrin disrupts Na channels, --> paralysis
-Ivermectin, increases inhibitory neurotransmission --> paralysis and death

the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems

-Surveillance/descriptive: based on Person-Place-Time (PPT)
-Analytical: based on Host- Agent- Environement (HAE)
-Experimental

prevalence = number of PEOPLE ALIVE with the disease. Affected by incidence and death/cure

incidence = number of NEW CASES diagnosed within a given period of time