JINNAH SINDH MEDICAL UNIVERSITY

1

Spiral II, 2019-2020 MODULE TITLE Infectious Diseases

INTRODUCTION

Pakistan is facing a double burden of disease (BoD), with endemicity of hepatitis B and

C with 7.6% affected individuals; the 5th highest tuberculosis burden in the world, and

focal geographical area of malaria endemicity. The overall HIV prevalence of 21.0%,

although 77.0% of those who inject drugs are using sterile injecting equipment. In

addition, the country has high rates of unscreened blood transfusions. Drug-resistant

tuberculosis is estimated at 4.3% among new cases and 19.0% among previously

treated cases. Vaccine preventable diseases and new emerging infections call for

strengthening disease surveillance and response system. High government

commitment and partners’ engagement resulted in a dramatic drop in the number of

polio cases to only 08 cases reported from 7 districts in 2017, as compared to 20 cases

from 14 districts in the preceding year. In young children, diarrhoea and respiratory

illness remain as the majorkillers.

RATIONALE

Considering the prevalence of infections in Pakistan, it becomes imperative that

infectious diseases get a special slot in the curriculum. It is kept strategically at the start

of 3rd year MBBS so that students are able to understand key issues early in the clinical

years. This module is intended to help students become aware of the etiology, risk

factors and preventive measures related to infections. Also, it is aimed that the learners’

ability to deal with patients in the wards will improve once their core knowledge is

sound.

TARGET STUDENTS 3rd Year MBBS, DURATION 06 weeks

JINNAH SINDH MEDICAL UNIVERSITY

2

MODULE OUTCOMES

By the end of the six-week module, all the students of 3rd year MBBS will be able to:

relate the etiology and pathogenesis of common adult andpaediatric

infectious conditions with their clinical manifestations and principles of

management (includingtherapeutics)

relate diagnosis of infectious conditions with the burden of diseasewithin

and outside Pakistan

describe legal issues and general toxicology in Forensic Medicine &

Toxicology

DEPARTMENTS

Community Medicine

Forensic Medicine& Toxicology

Peadiatrics

Pathology

Pharmacology

Internal Medicine

OBJECTIVES By the end of the module, all the 3rd year MBBS students will be able to:

JINNAH SINDH MEDICAL UNIVERSITY

3

COMMUNITY MEDICINE

Introduction & Definition of communicable and infectious diseases. • Define the following terms: infection, infestation, infection agent, control,

elimination and eradication, agent, host andenvironment • Discuss the role of incubation period, serial time period in control ofinfection • Describe the epidemiologictriangle

Control of infection and communicable diseases.

• Differentiate between infectious and communicablediseases • Differentiate between the disinfection andsterilization • Describe control measures for infectious & communicablediseases • Explain the role of immunprophylaxis& screening in the control ofinfection

Measles And its prevention. • Describe the etiology, epidemiology,control and prevention ofmeasles • Describe the clinical features, assessment and diagnosis ofmeasles • Discuss the role of immunization in prevention ofmeasles

JINNAH SINDH MEDICAL UNIVERSITY

4

Pertussis and its prevention • Describe the etiology, epidemiology,control and prevention ofPertussis • Describe the clinical features, assessment and diagnostic criteria ofPertussis • Discuss the process of control and prevention ofPertussis

Scabies and its prevention

• Describe the etiology, epidemiology,control and prevention ofScabies • Describe the clinical features, assessment and diagnostic criteria ofScabies • Discuss the process of control and prevention ofScabies

Acute Diarrheal disease and its prevention.

• Describe the etiology, epidemiology,control and prevention of Acute Diarrheal diseases

• Describe the clinical features, assessment and diagnostic criteria of Acute Diarrheal diseases

• Discuss the process of control and prevention of Acute Diarrhealdiseases

Cholera and its prevention • Describe the etiology, epidemiology, risk factors, control and prevention ofCholera • Describe the clinical features &diagnostic criteria ofCholera • Discuss the process of control and prevention ofCholera

JINNAH SINDH MEDICAL UNIVERSITY

5

Worm infestations and their prevention • Describe the epidemiology, risk factors, control and prevention of worminfestations • Describe the clinical features &diagnostic criteria of worminfestations • Discuss the process of control and prevention of worminfestations

Zoonotic diseases and their prevention • List Different Zoonoticdiseases • Describe the etiology, epidemiology, risk factors, control and prevention of Zoonotic

diseases • Describe the clinical features & diagnostic criteria of worminfestations • Discuss the process of control and prevention of worminfestations

Leishmaniasis and its prevention. • Describe the etiology, epidemiology, risk factors, control and prevention of

Leishmaniasis • Describe the clinical features & diagnostic criteria ofLeishmaniasis • Discuss the process of control and prevention ofLeishmaniasis

Emerging and re-emerging diseases and their prevention.

• List different emergingdiseases • Describe the etiology, epidemiology, risk factors, control and preventionof

Emerging And re-emergingdisease

JINNAH SINDH MEDICAL UNIVERSITY

6

FORENSIC MEDICINE&

TOXICOLOGY

Introductory class

Define Forensic Medicine and Toxicology and its variousbranches

Discuss the importance and utility of Forensic Medicine and Toxicology andits

various branches, its role in crime detection and other medical, legal and

ethical issues in civilizedsociety.

Describe the basics of Legal system inPakistan

Discuss the types of Courts in Pakistan and theirpowers

JINNAH SINDH MEDICAL UNIVERSITY

7

Legal Procedures - I

Define important legal terms such as Summons, warrant, perjury, deposition,

exhibit, offence, cognizable offence, non cognizable offence, oath, conduct

money, summons case, warrant case, bail,FIR,

Describe Medical evidence, types of evidence (oral, documentary,hearsay,

circumstantial)

Discuss the Documents prepared by a medical man(Post mortem Reports,

Medico Legal Reports, Certificates such as birth certificates, deathcertificates,

sickness certificates, certificates of unsoundness ofmind)

Differentiate between dying declaration and dyingdeposition

Legal Procedures – II

Define the types of witnesses, types of examination in thecourt

Discuss the recording of evidence and procedure of court attendance with

special emphasis on the guidelines for doctor in the witnessbox

Describe Professional secrecy and Privilegedcommunication

Legal Procedures – III

Describe the Criminal Justice system inPakistan,

Describe Pakistan Penal Code, Criminal Procedure Code and its executionand

delivery

List the general presumptions and exemptions oflaw

General Toxicology

DescribeToxicology

JINNAH SINDH MEDICAL UNIVERSITY

8

Classify poisons according to chiefsymptoms

Discuss the medico legal classification and International toxicity rating ofpoisons

NOTE: Rest of General Toxicology will be taught in tutorials

Laws in relation to medical man – I

Discuss medical ethics and itssignificance

Describe Hippocratic Oath and principles ofBioethics

Discuss the duties of doctor as advised by international code of medicalethics

Describe the composition, functions of Pakistan Medical & Dental Councilat

present and its role in medicaleducation

Laws in relation to medical man – II

By the end of the lecture the candidate should be able to discuss:

Privileges & obligations of registered medicalpractitioners

Professional misconduct (Infamous conduct) andconsent

Types of consent and the role of consent in MedicalExamination

Criteria for giving validconsent

Doctrine of informed consent (Rule of fulldisclosure)

Certain legal deviations/exemptions ofconsent

Laws in relation to medical man-III

By the end of the lecture the candidate should be able to describe:

Professionalnegligence

Types ofnegligence

Res- Ipsa-Loquotar

NovusActusInterveniens

JINNAH SINDH MEDICAL UNIVERSITY

9

VicariousLiability

Laws relation to medical men – IV

List 5 D’S for plaintiff’ssuccess

Define Euthanasia and itstypes

Discuss Compensation For Medical Negligence

Describe the defenses for defendant doctor and defenses for reducing

damages

Describe Transplantation of Human Organs and Tissues Act2010

Discuss Ethical issues related toeuthanasia

FORENSIC MEDICINE

DEMONSTRATIONS

General Toxicology I:

By the end of the tutorial the candidate should be able to:

Definepoison.

Differentiate between poison andmedicine

Describe the routes of administration and excretion ofpoisons

List the Factors modifying action ofpoisons.

General Toxicology II:

By the end of the tutorial the candidate should be able to discuss the methods of

diagnosing poisoning in living & dead

General Toxicology III:

By the end of the tutorial the candidate should be able to discuss:

The duties of a doctor in a case of suspectedpoisoning

General principles of treatment ofpoisoning

JINNAH SINDH MEDICAL UNIVERSITY

10

Gastric lavage

Antidotetherapy

General Toxicology IV:

By the end of the tutorial the candidate should be able to describe the role of

Poisoning Information Centre in treatment of cases of poisoning

INTERNAL MEDICINE

Pyrexia of Unknown Origin (PUO)

Define Pyrexia of UnknownOrigin

Discuss the criteria ofPUO

List the investigations related toPUO

Develop an outline of management plan forPUO

Malaria

DefineMalaria

Classify itstype

Discuss the clinical features & complications of Malaria

List the investigations related to malaria

Develop an outline of management plan formalaria

Enteric fever

• Define Enteric fever

• Discuss the clinical features & complications of Entericfever

• List the investigations related to Enteric fever

• Develop an outline of management plan for Entericfever

Viral hemorrhagic fever

• Define Dengue, Lasa and Congofever

• Discuss the clinical features & complications of Dengue, Lasa and Congofever

• List the investigations related to Dengue, Lasa and Congofever

JINNAH SINDH MEDICAL UNIVERSITY

11

• Develop an outline of management plan for Dengue, Lasa and Congofever

Human Immunodeficiency Virus (HIV)

• Define Human Immunodeficiency Virus(HIV)

• Discuss the clinical features & complications of HIV

• List the investigations related to HIV

• Develop an outline of management plan forHIV

Acute Diarrhea

• DefineDiarrhea

• Classify its type

• List the investigations related toDiarrhea

• Discuss the complications ofDiarrhea

• Develop an outline of management plan for Diarrhea according toIMNCI

Fungal Infections

Define clinically important fungalinfections

Classify its type

Discuss itssyndromes

Discuss the clinical features of fungalinfections

List the investigations related fungal infections and theircomplications

Develop an outline of management plan for theseconditions

Nematodes

• Definenematodes

• ClassifyNematodes

• Discuss the clinical features & complications ofnematodes

• List the investigations related nematodes

• Develop an outline of managementplan

JINNAH SINDH MEDICAL UNIVERSITY

12

Trematodes

• DefineTrematodes

• ClassifyTrematodes

• Discuss the clinical features & complications due toTrematodes

• List the investigations related Trematodes

• Develop an outline of managementplan

Cestodes

• DefineCestodes

• ClassifyCestodes

• Discuss the clinical features & complications ofTrematodes

• List the investigations related Trematodes

• Develop an outline of managementplan

Viral infections

• Define mumps, measles, cytomegalo virus, infectiousmononucleosis

• Classify theseconditions

• Discuss the clinical features & complications of Mumps, Measles, Cytomegalo

Virus (CMV), InfectiousMononucleosis

• List the investigations related mumps, measles, CMV & InfectiousMononucleosis

• Develop an outline of management plan for theseconditions

JINNAH SINDH MEDICAL UNIVERSITY

13

PATHOLOGY &

MICROBIOLOGY

Overview of infectious diseases

Classify bacterial, viral, fungal and parasiticdiseases

Describe clinical significance of infectious diseases with respect to organsystems

Acute and chronic inflammation

Discuss pathogenesis of acute and chronicinflammation

Sepsis/ SIRS

Describe inflammation leading to Sepsis and SIRS Typhoid fever

Discuss microbiology of typhoid and paratyphoid fever and its burdenin

endemiccountries Gram negative infections

Describe the importance of gonococcal infections and itspathogenesis

Summarise main features of Pertussis and Pseudomonasinfections

Gram positive infections (3)

Describe Skin and soft tissue infection ( boils, furuncles, folliculitis) withcausative

organisms

Describe Importance of blood culture and its significance in diagnosisof

infectious diseases (endocarditis, typhoid)

Describe the process of performing and interpret Stool urine detailed report,

Culture, PCR,Serology.

Mycobacterial infections

Explain the pathogenesis ofleprosy.

Briefly discuss Tuberculous and Non-Tuberculous Mycobacterialinfection Anaerobic infections

Describe Clostridial infections caused by C. Perfringes, Difficile, Botulinum,Tetani.

Discuss the Pathogenesis ofTetanus

JINNAH SINDH MEDICAL UNIVERSITY

14

Viralinfections

Discuss common organisms in relation to fever with rash and theirpathogenesis

Discuss measles, rubella, varicella,mumps.

Parasitic infections (9)

Classify viral haemorrhagicfevers.

Describe the Importance of dengue fever andVHF

Summarise main features of rabiesvirus

Discuss the Pathogenesis of Rabies and its clinicalfeatures

Summarise main features of herpes family ofviruses

Describe Latent viral infections (hsv1-6, VZV,CMV,EBV)

Describe Retrovirus in relation to HIV and its pathogenesis to causeAIDS

Discuss various tests for diagnosis and screening of HIV, Westernblot,

immunofloresence,ELISA

Describe worm infestations by Trematode, Nematodes, andCestodes

Discuss malarial parasite and itspathogenesis

Discuss Bacterial and parasitic causes of diarrhea anddysentery.

Summarise main features of bacterial agents salmonella, shigella, vibrio,

campylobacter.

Summarise main features of diarrhea and dysentery causing ova andparasites

(entamoeba, ascaris,pinworm)

Summarise main features of microorganisms causing STD ( Chlamydia,Neisseria,

Chancre, Condyloma, Syphilis, Trichomonas)

Fungal infections

Classify fungi into yeast andmold.

Describe various fungal infections causing Thrush, Ringworm, Aspergillosisand

Mucormycosis

JINNAH SINDH MEDICAL UNIVERSITY

15

Vaccine preventable infectious diseases

Discuss vaccine preventableinfections

Enumerate vaccines included in EPI (BCG, OPV/IPV, DPT, MMR, Hep B, Hib,)

PHARMACOLOGY

Introduction to Chemotherapeutic Drugs

Explain the general principles of antimicrobial therapy and their classes and

mechanism(s) ofaction.

Discuss antimicrobial spectra of different drug classes, incidence ofdrug

resistance and its mechanisms and clinicaluses. Cell-wall Synthesis Inhibitors-I

ClassifyPenicillins

Describe the basic and clinical pharmacology ofPenicillins

Explain Pharmacokinetics and dynamics ofPenicillins

Cell-wall synthesis Inhibitors-II

Describe basic and clinical pharmacology of Cephalosporins and otherdrugs.

Enumerate classes and theirdrugs

Explain kinetics and dynamics of Cephalosporins and otherdrugs

Protein Synthesis Inhibitors-I

Classify Protein synthesisinhibitors

Describe the basic and clinical pharmacology of Tetracyclines &Aminoglycosides

Explain Pharmacokinetics and dynamics of Tetracyclines &Aminoglycosides

Protein Synthesis Inhibitors-II

JINNAH SINDH MEDICAL UNIVERSITY

16

ClassifyMacrolides

Describe the basic and clinical pharmacology of Macrolides

Explain Pharmacokinetics and dynamics of Macrolides &others

Anti-metabolites drugs-I

Classify the Fluoroquinolones.

Explain their Pharmacokinetics, dynamics and their clinical uses

Anti-metabolites drugs-II

Classify Sulfonamides and Trimethoprim

Explain their Pharmacokinetics, dynamics and their clinicaluses

Anti-Protozoal drugs

Classify Anti-protozoal drugs & anti- malarialdrugs,

Describe their Pharmacokinetics and dynamics.

Treatment of infectious Diarrhea &Amoebiasis

Explain various Antibiotics used in diarrhea and their Pharmacokinetics and

dynamics.

Classify Anti-Amoebic drugs

Describe their Pharmacokinetics and dynamics

Treatment of Typhoid Fever

Enumerate the drugs used in the treatment of Typhoidfever

Describe their Pharmacokinetics and dynamics

Anti-Viral Drugs

Classify various drugs used in the treatment of various viral infections

Explain their pharmacokinetics and dynamics

JINNAH SINDH MEDICAL UNIVERSITY

17

Anti-Helminthic Drugs

Classify various drugs used in the treatment of Helminthic infections

Explain their pharmacokinetics and dynamics

JINNAH SINDH MEDICAL UNIVERSITY

18

PEDIATRICS

Integrated Management of Neonatal and Childhood Illnesses (IMNCI)

Explain the role & goals of IMNCI Describe the components & structure of IMNCI.

Describe the case management strategy of IMNCI.

Diarrhea. Describe the Diarrhoea and dehydration.

Differentiate between acute and chronic diarrhoea

Enumerate the risk factors & causes for acute diarrhoea

Assess degree of dehydration in the patient

Explain the management protocol for diarrhoea Describe the treatment plan for various degrees of dehydration

Describe Dysentery in children

Explain the management protocol for dysentery

Respiratory Tract Infections (RTI) in children

Describe the clinical features of RTI in children. Classify RTIs according to the symptoms as per IMNCI classification.

Diagnose pneumonia on the basis of clinical features

Diagnose sore throat in children on the basis of data provided

Explain the management protocol for sore throat & cough in children

Vaccinations Describe the EPI schedule.

List the dose, route and site of EPI vaccines.

Explain the protocol for management of side effects of vaccination.

Formulate the vaccination schedule for different age groups

Differentiate among various types of rashes in children Diagnose Measles based on clinical features.

Explain the management protocol for measles with complications List additional vaccines.

JINNAH SINDH MEDICAL UNIVERSITY

19

Internal Assessment:

Internal assessment will be conducted as per institutional policy. It carries 20%

weightage in final examination.

Annual Examination MCQs and OSPE (observed + Un observed).