Differences of communicable diseases Tuberculosis Suspected case : *cough, expectoration >3w, fever, loss Wt, NIGHT sweating Confirmed

case : Pulmonary TB smear + 1. + sputum for AFB of direct ME 2 initial specimens 2. + sputum for AFB of direct ME 1 smear specimen + radio abnormal for active pulmonary TB 3. + sputum for AFB of direct ME + + culture for AFB Pulmonary TB smear 1. At least 3 sputum smear + radio abnormal for active pulmonary TB + decision to treat with full course anti TB 2. sputum + +culture Extra pulmonary TB 1. + culture + histological evidence with active extrapulmonary + decision to treat with full course anti TB. Worldwide *urban areas : slum dwellers, lower socioeconomic groups. Re-emerging reasons ** ** Meningitis Suspected case : SUDDEN onset fever, stiffness neck, altered consciousness, other meningeal signs/ peticheal rash Confirmed case : + culture CSF *complications : Deafness Blindness Otitis media Arthritis Influenza Fever Headache Sore throat Cough Coryza Myalagia Complications : Resp - pneumonia, acute bronchitis CNS encephalopathy, post influenza depression, transient peripheral neuritis 2 syndrome toxic shock syndrome, Reye syndrome Others - otitis media, MYOcarditis, exacerbations of underlying chronic conditions. Fatal kalau : Elderly, immunosup, debilitated. Worldwide, temperate and tropical countries. Hot dry regions : mid African countries Meningitis belt) Winter, spring Children, young adult Male Adult (crowded): military 3-4 days Pandemics, epid, localized outbreak and sporadic.

Standard case definition :

Place

Time Person

Winter, H1N1 (spring) Any age any sex

IP

Agent Reservoir

-Infection till 1ry lesion : 4-12 w -Infection till progressive pulmonary / extrapulmonary : 6-12m Mycobacterium TB Human : pulmonary TB with + sputum for AFB Bovine : infected cattle No treatment @ not fully treatment + sputum Unpasteurized milk (infected cattle). Nose and mouth (human) Udder of infected cattle (bovine) CONTACT DROPLET AIR BORN TRANSMISSION INGESTION UNPASTEURIZED MILK RARE : Contact contaminated articles. Nose and mouth Moderate : measured by 2nd attack rate.

1-3 days

NM gram diplococcic Major epid : A,C, lesser B Most common : carrier

Influenza A, B , C Man, Bird reservoir (turkey, duck, chicken),Mammalian (swine,horses) Discharge nose and mouth

SOI

Discharge nose and mouth

Exit MOT

Nose mouth DIRECT CONTACT- DROPLET INFECTION X indirect : delicate Nose mouth

Nose mouth DIRECT : CONTACT, DROPLETS INDIRECT : contaminated ARTICLES with discharge AIR BORN Nose mouth 3-5 days 1. Inactivated, LAV (diff of both)

Inlet Period communicable Vaccine BCG vaccine : type LAV**

Purified meningococcal POLYSAC No vaccine : group B NM

TETANUS (LOCK JAW) Standard case definition :

Adult type :
-abnormal rigidity - generalized spasm induced sensory stimuli. -painful muscular contraction 1.masseter, neck Ms 2.trunk Ms, Ms of face (risus sardonicus)

ANTHRAX Cutaneous : -Localised itching, Painless papulevesicularulcer black eschar -2ry vesicles, Hyperemia, Lymphadenopathy. -Fever, headache, malaise GIT : intestinal, pharyngeal forms. **shock, death Inhalation : mimic influenza -myalgia, fever, non prod cough, malaise, NV, URT rare -SEVERE (after2-3d) severe resp distress, cyanosis, diaphoresis, shock. May occur all : Hge meningitis Agricultural areas. Sporadic : US, Canada. INGESTION CONTAMINATED vegetation, water, soil 1. travelers endemic areas DIRECT INDIRECT with CARCASSES 2. people MAKE DRUMS CONTAMINATED HIDES. HOUSEHOLD drum making process. 3. WOOL sorters workers. 1-7 d BACILLUS anthracis gram + aerobic, SPORE, encapsule.

Neonatal :
Suspected case : any death 3rd-28th days of life. Confirmed case : -normal suck and cry 1st, 2nd -inability to suck 3rd-28th -episodes convulsions, stiffness Place Time Person World wide, sporadic Agricultural, underdeveloped Summer high humidity All ages esp <15y, agricultural : adult male. Newborn.

RABIES 100% FATALITY ACUTE FATAL ENCEPHALOMYELITIS Short prodrome : - Headache - Fever - Malaise - Indefinite sensory changes at site wound Paralysis : Ms of deglutition (hydrophobia) Resp Ms : resp paralysis- death

Developing USA : BAT AIR BORN transmission. ANY TIME all year At risk : MEN AND CHILDREN. LAB WORKER handling Vs VETERINARIANS DOG HANDLERS FIELD NATURALISTS

IP Agent

4-21 days : mean 10 d. Neonatal : 2d Clostridium tetani gram + anaerobic bacilli (neurotoxin). 2 items kill.** Soil and intestinal tract

4d-1y **5 factors Neurotropic Vs saliva, lymph, milk and urine infected animals. Street Vs (rabid animals), Fixed Vs (lab) Urban rabies : dog, cats, horses, camel. No HEALTHY CARRIER : DOGS Wild type : fox, jackals, raccoons, bats. HEALTHY CARRIER present. SALIVA OF infected animals MOUTH infected animals DIRECT CONTACT with INFECTED SALIVA thru BITE of INFECTED animals DIRECT CONTACT OF LAB WORKERS exposed to infected tissues skin abrasion, intact MM.

Reservoir

SOI Exit MOT

Soil, street dust contain SPORES Stool of animals esp horses. INJURY- CONTAMINATED WOUND with soil, street dust, animal faeces. ** UNHEALED UMBILICUS EAR PIERCING, CIRCUMCISION. Wound, puncture, burns, umbilicus stump

DIRECT CONTACT with infected animals, with contaminated products- CARCASSES, MEAT, HIDES, WOOL, DRUM. -Cutaneous : skin abrasion -GIT : Ingestion uncooked meat -Inhalational : inhalation spores.

Inlet Period communi cable Vaccine

Abraded skin, intact MM.

NON COMMUNICABLE
** TETANUS TOXOID

NON COMMUNICABLE
Cell free Vac bacterial Ag -Not recommended to travelers

NON COMMUNICABLE
HCDV prepared in culture of human diploid fibroblast cells.

Standard case definition :

PLAGUE Suspected case : Fever, chill, severe malaise, headache + bubonic : extreme painful swelling of lymph glands. pneumonic : cough, blood stained sputum, chest pain, diff breathing Confirmed : Isolation of YP from buboes, CSF, sputum Elevation Abs Complications : 2ry septicemic plague HIGH CASE FATALITY RATE : septicemic, pneumonic plague

YELLOW FEVER Suspected case : Acute fever Jaundice within 2wof onset of 1st ssx. Late dis : Hge manifest Confirmed case : Epidemiological criteria OR Lab criteria - Isolation of yellow fever Vs - Serology : detection of specific IgM, rising IgG - Positive post mortem liver pathology.

Place

Sylvatic @ wild rodent plague : many countries Urban @ human plague : controlled, endemic in some countries. FLEA breading, summer and autumn. ALL ages, sexes. Men hunting : in contact with rodents during hunting, cultivating, outdoor recreation. Movement people sea and land.

Time Person

Urban type : both sexes, all ages Jungle type : ADULT MALES (20-40y) exposed to the dis during HUNTING, WOOD CUTTING, VILLAGERS

IP Agent Reservoir

6d
Yersinia pestis. 6 kill. ** Bubonic plague : sylvatic plague WILD RODENTS PRE DOMESTIC RODENTS DOMESTIC RODENTS MAN : RABBITS, DOMESTIC CATS Pneumonic : MAN in the form of case of pneumonic plague. Bubonic plague : INFECTED RODENT FLEA (XENOPSYLLA CHEOPSIS) Pneumonic : RESP DISCHARGE of cases. Bubonic, 1ry septicemia plague : SKIN of RAT. Pneumonic : RESP discharge of Pt in Bubonic, 1ry septicemia plague : BITE OF INFECTED FLEAS (VECTOR biological propagative transmission) 1ry pneumonic plague : DROPLET CONTACT, AIR BORN ( DROPLET nuc) DIRECT : INFECTED tissues, fluids from handling sick, dead animals esp rodents, rabbits. Bubonic, 1ry septicemia plague : SKIN. 1ry pneumonic plague : RESP TRACT. Months Bubonic plague : NON COMMUNICABLE unless complicated with 2nd pneumonic plague. Pneumonic plague : HIGHLY

6d
Vs of yellow fever

Urban type : HUMAN Jungle type : MONKEY

SOI

Exit MOT

Urban type : infective FEMALE AEDES egypti mosquitos. Jungle type : FOREST MOSQUITOS (Aedes AFRICANS, SYMPSONI) Skin of mosquito bite. BITE OF INFECTIVE MOSQUITO (vector, biological, propagative transmission). TRANSOVARIAN

Inlet Period communic able

Skin of mosquito bite. Before onset of fever and first 3-5 days of illness.

COMMUNICABLE.
Vaccine 17 D strain, freeze dried LAV **