Viral or Bacterial?

Some doctors do not like asking questions. But I have this chronic ‘disease’ of asking questions. Thus, once, when the doctor said:

“Its viral”

I responded:

“How do you know?”

Then I realized that how irritating such a question is, for a doctor. So I explained:

“I just want to know how you doctors comes to a conclusion that its viral”

That was the time I got introduced to this doctor and now he is sooooooo used to me. So, he will be surprised if I did not ask any question during a visit.

Last Friday, I went to meet him since my son was having a cold and cough. And in the present scenario, the school authorities ask for medical certificate even for a day’s absence. The doctor said:

“It’s viral only, but no need to worry”

(What he meant was, there is no need to suspect H1N1)

“......It looks like all the viruses are on a spree… did you notice that kid waiting outside? He has chickenpox; so I asked them to leave immediately..... This is not the season for that virus”

Yes, I noticed him asking me to sit in his consulting room and going outside (to attend that kid first)

“Oh, that’s interesting…usually that comes during summer..but its OK, my son already had chickenpox when he was small” I responded

“Yes, I know”

(True, but I did not expect him to remember that. So this guy has good memory, huh !)

So, how do these docs distinguish between a viral and bacterial infection?

If it is something like chickenpox, rabies (both viral), tuberculosis, syphilis (both bacterial) etc its easy for them.But what about a cold like symptom? A cough? Sore throat? Fever?

In reality, what matters is their experience (or gut feeling) if the patient visits the doc at a very early stage. Because without doing any test, they cant simply say its viral or bacterial, in the early stage. (that is one reason why they ask ‘when did it start?’…if our complaint was a cold with nasal discharge and suffering since 10 days or so, doc might rule out virus. Usually, virus infections won’t stay for more than a week. Our body will fight it out, if it can, within that period – I am talking about common cold and seasonal flu. But a bacterial infection can be chronic/ lengthy).

How can they confirm? Testing for a virus is a costly affair (plus there are very few virology labs compared to the regular labs) so what they do is checking whether its bacterial or not, if at all they want to test (usually the docs don’t suggest a test for seasonal diseases; at least my doc). Here, what they do a culture test (means taking a sample and keeping it in nutrient medium to observe whether there is bacterial multiplication. If it is positive, they conclude that its bacterial; if negative they assume that its viral).

But sometimes a viral cold can lead to bacterial infection (depends on many factors like a person's immunity, contact with infected person or surfaces etc). I have personally experienced this. This can be noticed by the color change in the nasal discharge. That is one reason why a doc sometimes prescribe an anti-biotic for a flu or cold, even though it has no direct impact on a virus. Usually, viral infections are fought out by our body using its immunity mechanism.

How do these infections differ and what is the difference between an antibiotic and antiviral?

Though it’s a silly answer, bacterial infections are caused by bacteria and viral infections are caused by virus. But the style of their attack is very different.

Virus is not a living organism and hence we can not kill them using a drug. Virus need a living host cell for their existence. They are just a shell made up of some proteins and organic compounds (means a compound which has carbon atom). Inside the shell, there is some genetic material (eg. materials found inside a nucleus) like DNA or RNA (explaining DNA and RNA is out of scope of this particular blog). They can’t reproduce themselves and hence they hijack our cells and ‘command’ them to produce their replica (virus). Usually they use up our cell and its resources, kills it, detach from the cell and moves on. One technique used in anti-viral drug is that it interferes with this detaching process in such a way that the virus can not detach. Thus we can control them.

But a bacterium is a living cell and hence it can reproduce by division. So they can survive even in non living environment (like a cell phone or door knob) for a long time and even multiply. They produce toxins and this will damage the cells that are infected by them. Since they are living, they can be killed and that is what an antibiotic do.

Its just one ‘aaaaaachum’ but there is a wonderful script behind this story…