Communi

cabl
eDi
seases
Tabl
eofCont
ent
s
CHAPTERONE:
I
NTRODUCTI
ON
1Lear
ningObj
ect
ives
2Epi
demi
ologyandScopeofCommuni
cabl
eDi
seases
3Epi
demi
ologi
cal
Ter
msandDef
ini
ti
ons
4Rev
iewQuest
ions
CHAPTERTWO:
DEFI
NITI
ONS,
DESCRI
PTI
ONSOFTHETRANSMISSI
ON,
PREVENTI
ONANDCONTROLOFCOMMUNICABLE
DI
SEASES
1Lear
ningObj
ect
ives
2Communi
cabl
eDi
seases
3Chai
nofDi
seaseTr
ansmi
ssi
on
4Car
ri
erandI
tsTy
pes
5Ti
meCour
seofI
nfect
iousDi
seases
6Lev
elsofPr
event
ion
7Communi
cabl
eDi
seaseCont
rol
9Rev
iewQuest
ions
CHAPTERTHREE:
ORAL-
FECALTRANSMI
TTEDDI
SEASES
1Lear
ningObj
ect
ives
2I
ntr
oduct
ion
3FecesMai
nlyi
nWat
er
4FecesMai
nlyi
nSoi
l
5Di
rectCont
actwi
thFeces
Rev
iewQuest
ions
CHAPTERFOUR:
AI
R-BORNEDI
SEASES
1Lear
ningObj
ect
ives
2I
ntr
oduct
ion
3CommonCol
d
4Measl
es
5I
nfl
uenza
6Di
pht
her
ia
7Per
tusi
s
8Pneumococcal
Pneumoni
a
9Meni
ngococcal
Meni
ngi
ti
s
10Tuber
cul
osi
s
Rev
iewQuest
ions

Abbrev i
at ionsandAcr ony ms
AFBAci dFastBaci l
li
AIDSAcqui redI mmuno- Def i
ciencySyndr
ome
BCGBaci llusofCal mat e-Gui r
ein
Bi
dBi esi ndi es( t
wot imesaday )
B.Sc.Bachel orofSci encedegr ee
C0Degr eeCel sius
CNSCent ral NervousSy stem
CSFCer ebr o-spinalfl
uid
CTComput erizedTomogr aphy
DECDi et hy lcarbamazi nCi trat
e
DOTSDi rect l
yObser vedTr eatmentShortcour
se
GITGast ro-intesti
nalTr act
HIVHumanI mmuno- def iciencyVirus
I
gM Immunogl obli
nM.
I
MI ntramuscul ar
I
UI nt
er nat ional Unit
I
VI nt
rav enous
KgKilogr am
MOHMi nist r
yofHeal th
MRIMagnet i
cResonanceI maging
OPVOr alPol i
oVacci ne
POPeros( permout h)
PTB+SmearPosi tivePul monar yTuber culosis
QIDQuadr isi ndi es( fourt i
mesaday )
STDSexual lyTr ansmi t
tedDi sease
STISexual lyTr ansmi t
tedI ll
ness
TBTuber cul osi s
TidTriesi ndi es( threet imesaday )
URTIUpperRespi rat oryTr actInfect i
on
CHAPTERONE
I
NTRODUCTI ON
1Lear ningObj ect iv es
Attheendoft hischapt er,thest udentwi l
lbeabl et o:
Describet hebur denofcommuni cabledi seases
Defineepi demi ologyandepi demi ological terminologies.
Identif
yt hemaj orcommuni cabledi seasest hatpose
Healthpr obl ems
Diseasescanbecl assifiedaccor dingtot womaj or
Dimensi ons, namel yt het imecour seandcause.Accor di
ng
to
thetimecour se, theyar ef urtherclassifiedasacut e
(Characterizedbyar apidonsetandashor tdurati
on),and
Chronicdi sease( char act eri
zedbypr ol
ongeddur ation).
Basedont hecause, diseasescanbebr oadl ycategor i
zed
as
Infect i
ous, (i
.e.causedbyl i
vingparasiti
cor ganismssuch
as
viruses, bact eri
a, parasi t
icwor ms, i
nsect s,etc.)
,oras
noni nfect ious
(whi char ecausedbysomet hingotherthanal ivi
ng
par asiticor gani sm) .
Howev er ,
mostoft hecommondi seasesi nAf r
icaare
env ironment al diseases( i
nf ecti
ous)duet oinfecti
onby
l
iving
Communi cabl eDi seaseCont rol
organi sms.Thesear ecal ledcommuni cabl ediseases,
becauset heyspr eadf rom per sontoper son, orsometimes
from ani mal st opeopl e.Theyoccuratal l agesbutar e
most
ser i
ousi nchi l
dhoodandt heyar etoagr eatext ent
prev ent able.I ndev elopedcount r
ieswher et heyhavebeen
prev ent ed, otherheal thcondi ti
onssuchasacci dentsand
degener ati
v ediseasesbecomet hemostcommon.
Ther efor e,
communi cabl ediseasesr emai nveryimpor tantin
dev elopi ng
count r
iesbecause:
Manyoft hem ar ev erycommon
Someoft hem ar eser iousandcausedeat handdi sabil
it
y
Someoft hem causewi despr eadoutbr eaksofdi seaseor
epidemi cs
Mostoft hem ar epr ev entablebyf airlysimpl emeans.
Poorsoci o- economi cstatusoft hei ndi vi
dual smakes
them
vulnerablet oav ar i
etyofdi seases
Loweducat i
onal status
Epi demi ol ogi calTer msandDef initions
Epidemi ol ogy -thest udyoft hef requency ,distri
but i
onand
determi nant sofdi seaseandot herheal threlated
condi t
ionsi n
humanpopul ati
ons, andt heappl icat ionoft hisst udyt o
the
Communi cabl eDi seaseCont rol
promot i
onofheal thandt othepr ev ent i
onandcont rolof
heal t
h
problems.
Someoft hecomponent sint hedef i
ni t
ionofepi demi ol
ogy
are:
Popul ations”Epi demi ologyf ocusesont heef fectsof
diseaseonpopul at i
ons
Diseaseandheal t
hr elatedcondi tions”Epi demi ology
i
ndi catest hatev erythi
ngar oundusandev erythingwedo
affectsourheal th.
Frequency "showst hat“ epidemi ology ”isaquant it
ative
science( e. g.occur renceofi l
lnessi smeasur edusi ng
mor bidityr ates) .
Di
stri
but i
on"refer
stotheoccurr
enceofdi seaseby
pl
ace,personandt ime.
Det
er minants”Thesearef
actorsthatdetermine
whetherornotaper sonwil
lgetadisease.

Thecausesofdi seasesar ecl assifi

edepi demi ologicall
y
Pr i
mar ycauses-Fact orsthatar enecessar yf oradi sease
to
occur ,andi nwhoseabsencet hediseasewi llnotoccur
(e.g.
i
nf ectiousagent s,vit
ami ndef ici
encies) .
1.Cont ributing, predisposing, oraggr avatingf act ors-
Riskf act orswhosepr esencei sassoci atedwi than
i
ncr easedpr obabi l
it
yt hatdiseasewi l
loccur /dev elop
l
at er(e.g.Pov ertyisthemostpower f
ul environment al
det ermi nanti nthedi seaseoccur rence, Habitofci garett
e
smoki ngl eadst olungcancer .Hav i
ngmul ti
plesexual
par tnersr esul t
si nSTI ).
Def init
ionofot herepi demi ologicalterms:
1.Epi demi cs-t heoccur renceofanyheal t
hr elated
condi tioni nagi venpopul ationinexcessoft heusual
frequencyi nt hatpopul ati
on.
2.Endemi c-adi seaset hatisusual l
ypr esenti na
popul at ionori nanar eaatamor eorl essst ablelev el
.
3.Spor adi c-adi seaset hatdoesnotoccuri nt hat
popul at ion, exceptatoccasi onal andi r
regularintervals.
4.Pandemi c-anepi demi cdiseasewhi choccur s
wor l
dwi de
5.Di sease-ast ateofphy si
ological orpsy chological
dysfunct i
on.
6.Inf ect ion-t heent r
yanddev elopmentormul ti
plication
of
aninf ect i
ousagenti nt hebodyofmanorani mal
7.Cont ami nation–pr esenceofl iv
ingi nf
ectiousagent
upon
arti
cles
8.Inf est at i
on–pr esenceofl ivingi nfecti
ousagentont he
exteriorsur f
aceoft hebody
9.Inf ect ious-causedbymi crobesandcanbet r
ansmi tted
toot herper sons.
10.Inf ect iousagent -anagentcapabl eofcausi ngi nfection
Rev i
ewQuest i
ons
3.Def inet hef oll
owi ngt er
ms:
-Epidemi ology
-Epidemi cs
-Endemi c
-Pandemi c
-Spor adi c
-Infect ionandi nf ectiousagent
CHAPTERTWO
DEFINI TION, DESCRI PTIONOFTHE
TRANSMI SSION, PREVENTI ONAND
CONTROLOFCOMMUNI CABLE
DISEASES
2.1Lear ningObj ectiv
es
Attheendoft hischapt ert hestudentwi l
lbeabl eto:
Def i
necommuni cabledi sease.
Descr ibet hef actorsinvolvedi nt hechai nof
Communi cablediseaset ransmi ssi on.
I dentifythedi fferentlevelsofdi seasepr ev enti
on.
Appl ythedi f
ferentcont rolmet hodsofcommuni cable
diseases.
2.2Communi cableDi seases
Thesear ei ll
nessesduet ospeci ficinfectiousagent sorits
toxi
cpr oduct s, whichar i
set hrought ransmi ssionoft hat
agent,
oritstoxicpr oduct sfrom ani nfectedper son, ani malor
i
nani mater eser voirtoasuscept i
blehost ,eitherdi r
ectl
yor
Communi cabl eDi seaseCont rol
i
ndirectly,throughani ntermedi atepl antorani mal host,
vector
orinanimat eenv i
ronment .

3Chai
nofDi
seaseTr
ansmi
ssi
on
Thisr eferst oal ogi cal sequenceoff actorsorl inksofa
chain
thatar eessent i
al tot hedev el
opmentoft heinfectious
agent
andpr opagat ionofdi sease.Thesi xfactor sinv ol
vedi nthe
chainofdi seaset ransmi ssionar e:
a.Infect i
ousagent( et i
ol ogyorcausat iveagent )
b.Reser voi r
c.Por talofexi t
d.Modeoft r
ansmi ssi on
e.Por talofent r
y
f.Suscept iblehost
a.Infect i
ousagent :Anor gani sm thati scapabl eof
Produci ngi nfect i
onori nf ect i
ousdi sease.
Ont hebasi soft heirsi ze, eti
ological agent sar egener al
l
y
classifiedi nto:
Met azoa( mul ticel l
ul arorgani sms) .(e.g.Hel minths).
Pr otozoa( Unicel l
ul aror ganisms)( e.g.Ameobae)
Bact er i
a( e.g.Tr eponemapal lidum, My cobact erium
t
uber culosi s,et c.)
Fungus( e.g.Candi daal bicans)
Vi rus( e.g.Chi ckenpox, poli
o, etc.)
b.Reser voi rofi nfect i
on:Anyper son, animal ,arthr
opod,
plant,soi lorsubst ance( orcombi nat i
onoft hese)inwhi ch
an
i
nf ecti
ousagentnor mal lyl i
vesandmul tipli
es, onwhi chit
dependspr i
mar ilyforsur v
ival andwher eitreproduces
i
tselfin
suchamannert hatitcanbet ransmi t
tedt oasuscept ibl
e
host .
Ty pesofr eservoi r
s
1.Man:Ther ear eanumberofi mpor t
antpat hogenst hat
are
specifi
cal l
yadapt edt oman, suchas: measl es,smallpox,
typhoid, meni ngococcal meni ngitis,gonorrheaandsy phi
li
s.
Thecy cl eoft ransmi ssionisf rom humant ohuman.
2.Ani mal s:
Somei nfect i
veagent sthataf fectmanhav etheir
reservoirinani mal s.Thet erm“ zoonosi s”isappliedto
disease
transmi ssionf rom ani malstomanundernat ural
conditions.
Forexampl e:
Bov i
net uber culosis-cowt oman
Brucel l
osis-Cows, pi
gsandgoat st oman
Ant hrax-Cat tle,sheep,goat s,horsest oman
Rabi es-Dogs, foxesandot herwi l
dani malstoman
Mani snotanessent i
alpart(usual reservoir
)ofthelife
cy cl
eoft heagent .
Ani mal ……. .Animal …………Ani mal
↓
Human
3.Non- l
ivi
ngt hingsasr eservoi r:Manyoft heagent sar e
basical lysapr ophy t
esl iv i
ngi nsoi landf ul
lyadapt edt oli
ve
freelyi nnat ure.Bi ologi call
y ,
theyar eusuallyequippedt o
wi t
hst andmar kedenv ironment al changesi ntemper ature
and
humi dity.
E.g.Cl ost r
idium bot uli
num et iologi cagentofBot ulism
Clost ri
dium t et ani etiologi cagentofTet anus
Clost ri
dium wel chi etiologi cagentofgasgangr ene
c.Por talofexi t(modeofescapef rom ther eservoir):This
i
st hesi tethroughwhi cht heagentescapesf r
om t he
reser voir.Exampl esi ncl ude:
GI T:typhoi df ever, bacill
ar ydy sentery,amoebi c
dy sentery ,chol era, ascariasi s, et
c.
Respi rator y:t uber culosis, commoncol d,etc.
Ski nandmucusmembr anes: Syphil
is
D.Modeoft ransmi ssi on( mechani sm oftransmi ssionof
i
nf ect i
on) :Ref er st othemechani smsbywhi chan
i
nf ect i
ous
agenti stransf er redf rom oneper sont oanot herorf r
om a
reser voirtoanewhost .Transmi ssi onmaybedi r
ector
i
ndi rect .
1.Di rectt ransmi ssi on:Consi st sofessent iall
yimmedi ate
transf erofi nfect iousagent sf rom ani nfectedhostor
reser voir
toanappr opr iatepor tal ofent ry .Thi scouldbe:
a.Di rectVer tical
Suchas: t
r anspl acent al transmi ssionofsy phili
s,HI V,etc.
b.Di recthor izont al
Directt ouchi ng, bi
ting, kissing, sexual intercourse, droplet
spreadont ot heconj unct ivaoront omucusmembr aneof
eye, noseormout hdur ingsneez ingcoughi ng,spittingor
tal
ki ng;Usual lyl i
mitedt oadi stanceofaboutonemet eror
l
ess.
2.Indi r
ectt ransmi ssi on
a.Vehi cle- bor net ransmi ssion:Indi r
ectcont actthr ough
cont ami nat edi nani mat eobj ects( fomites)l i
ke:
Beddi ng, toys,handker chiefs,soiledcl othes,cooki ng
or
eatingut ensi l
s, sur gical i
nstrument s.
Cont ami nat edf oodandwat er
Biological pr oduct sl ikebl ood,ser um, plasmaorI V- f
luids
oranysubst anceser vingasi ntermedi atemeansbywhi ch
ani nfectiousagenti st ranspor tedandi ntroducedi ntoa
suscept i
blehostt hroughasui tablepor talofent r
y .The
agentmayormaynotmul ti
plyordev elopint hev ehi cl
e
befor eitisi nt roducedi nt oman.
b.Vect or-bor net r
ansmi ssion:Occur swhent heinf ectious
agenti sconv ey edbyanar t
hropod( i
nsect )toa
suscept i
ble
host .
1Mechani calt r ansmi ssi on:
Thear t
hr opodt ranspor tsthe
agentbysoi li
ngi t sfeetorpr obosci s,inwhi chcase
mul t
iplicat ionoft heagenti nt hevect ordoesnotoccur .
(E.g.Commonhousef ly.)
2.Bi ologi calt ransmi ssi on:
Thi siswhent heagentmul ti
pli
es
i
nt hear thropodbef orei tistransmi tted,suchast he
transmi ssi onofmal ariabymosqui to.
C.Ai r-bor net ransmi ssion:
Dissemi nat ionofmi crobi alagent
byai rt oasui tabl epor t alofent ry,
usual l
yt herespi r
at ory
tract.
Twot y pesofpar t i
clesar eimpl i
catedi nthiskindofspr ead:
dust sanddr opl etnucl ei.
Dust :smal l i
nf ect i
ouspar t
icl
esofwi delyv aryi
ngsi zet hat
mayar isef rom soi l
,clot hes,beddi ngorcont aminat ed
fl
oor s
andber esuspendedbyai rcur rent
s.
Dr opletnucl ei:Smal l r
esi duesr esulti
ngf rom ev apor ati
on
of
fl
ui d( dropl et semi t
tedbyani nfectedhost ).Theyusual ly
remai nsuspendedi ntheai rforlongper iodsoft ime.
e.Por talofent ry :Thesi teinwhi cht heinfectiousagent
ent erst ot hesuscept i
bl ehost .
Forexampl e:
Mucusmembr ane
Ski n
Respi rat orytract
GI T
Bl ood
f.Suscept ibl ehost( hostfact ors):Aper sonorani mal
l
acki ngsuf ficientr esi st
ancetoapar t
icularpathogenic
agentt o
prev entdi seasei forwhenexposed.Occur r
enceof
i
nf ection
andi tsout comear ei npartdet erminedbyhostf actors.
Thet erm“ immuni ty ”isusedt odescr ibet heabil
it
yoft he
hostt o
resistinf ection.
Resi stancet oi nfect ionisdeter minedbynon- speci
ficand
speci fi
cf act ors:
Non- speci ficf act ors
Ski nandmucusmembr ane
Mucus, tears, gast r
icsecr eti
on
Ref l
exr esponsessuchascoughi ngandsneezi ng.
Speci fi
cf act ors
Genet ic- hemogl obinresistantt oPlasmodi um
falcipar um
Nat urallyacqui redorar ti
fi
ciall
yi nducedi mmuni ty.
Acquir
ed
i
mmuni tymaybeact i
veorpassiv
e.
Acti
veimmunity-acqui
redfol
lowingact
ual
inf
ect
ionor
i
mmuni zat
ion.

Passi vei mmuni ty-pre- f

ormedant i
bodi esgi v
ent ot he
host .
Car rierandI tsType
Acar rieri sani nfectedper sonorani mal whodoesnot
hav e
appar entcl i
nicaldiseasebuti sapot ent i
alsour ceof
i
nf ect i
on
toot her s.
a.Heal thyorasy mpt omat iccarr
iers:Thesear eper sons
whosei nf ectionremai nsunappar ent.Forexampl e,i
n
poliov irus, meni ngococcusandhepat i
ti
sv irusinf ecti
ons,
ther eisahi ghcar r
ierr ate.
b.Incubat or yorprecoci ouscar r
ier
s:Thesear ei ndividual
s
orper sonswhoexcr et ethepat hogendur i
ngt he
i
ncubat ionper i
od( i
.e.bef oretheonsetofsy mpt omsor
bef oret hechar acteristicfeaturesoft hedi seasear e
mani fest ed).
E.g.Measl es,mumps, chickenpoxandhepat it
is.
c.Conv alescentCar riers:Thesear et hosewhocont i
nue
to
har borthei nfect iveagentaf t
err ecov eri
ngf r
om t he
i
llness.E. g.Dipht her i
a, Hepat i
tisBv ir
us.
d.Chr onicCar rier s:Thecar ri
erst at epersi
stsf oralong
per i
odoft ime.E. g.Ty phoi df ev er,Hepat i
ti
sBv ir
us
i
nf ect i
on
2.5Ti meCour seofI nf ectiousDi seases
Incubat ionper iod: Itist hei nterval oftimebet ween
i
nf ect i
on
oft hehostandt hef i
rstappear anceofsy mpt omsand
signsof
thedi sease.
Pr odor malper iod: Itist hei nterval betweent heonsetof
sy mpt omsofani nf ectiousdi seaseandt heappear anceof
char acteristi
cmani fest ations.Forexampl e,inameasl es
pat i
ent ,f
ev erandcor y zaoccuri nthef ir
stthreeday sand
Kopl ickspot sint hebuccal mucosaandchar acteri
sti
cs
skin
l
esi onsappearont hef ourthday .
Per iodofcommuni cabi li
ty:
Theper ioddur ingwhi cht hat
par ti
cularcommuni cabl edi sease( infecti
ousagent )is
transmi ttedf r
om t hei nf ectedper sont othesuscept ibl
e
host .
Lev elsofPr event ion
Thedi ff
erentpoi nt sint hepr ogressi onofadi seaseat
whi ch
onecani nter venecanbecl assi fiedaccor di ngt ot hree
l
ev els
ofpr ev ent ion: primar y,secondar y,andt ertiar y.
Primar ypr ev ention:
Theobj ect i
v esher earet opr omot e
healt h, pr ev entexposur e, andpr eventdi sease.
Heal thpr omot i
on:
Thi sconsi stsofgener al non- speci fic
i
nter v ent ionst hatenhanceheal thandt hebody ’
sabi l
it
yto
resistdi sease, suchasmeasur esai medatt he
i
mpr ov ement
ofsoci o- economi cstat ust hr ought hepr ov isionof
adequat elypai dj obs, educat i
onandv ocat ional training,
affordabl eand
adequat ehousi ng, clothing, andf ood, ol d-agepensi on
benef its; emot ional andsoci al suppor t,reliefofst ress,et
c.
shor ti ti sanyi nter ventiont hatpr omot esaheal thierand
happi erl ife.
Prev ent ionofexposur e:-
Prev ent ionofdi sease: -Thi soccur sdur i
ngt helat ency
period
betweenexposur eandt hebi ologi calonsetofdi sease.An
exampl ef ort hisisi mmuni zat ion.
Immuni zat ionagai nstani nf ect iousor gani sm doesnot
prev ent
i
tf r
om i nv adi ngt hei mmuni zedhost ,
butpr ev entsi tfrom
establi
shi ngani nfection.Act iveimmuni zati
onmeans
exposingt hehostt oaspeci fi
cant i
genagai nstwhi chit
will
manuf act urei t
sownpr otectiveant ibodi esaf t
erani nterv
al
of
aboutt hreeweeks( duri
ngwhi cht hei mmuni zedper son
remainssuscept i
bletot hedi sease) .Passi ve
i
mmuni zat ion
meanspr ovidingt hehostwi tht heant ibodiesnecessar yto
fi
ghtagai nstdi sease.Bot hformsofi mmuni zati
onact
after
exposur e.Howev er,foract i
vei mmuni zat i
ont obe
protective,
thetimingofi t
sadmi nistrati
onmustbeatl eastthree
weeks
priortoexposur e.Passi veimmuni zat i
on, ont heother
hand,
i
scommonl ygi venaf terexposur ehasoccur red(asi nthe
caseofexposur etor abiesort etanus) ,orshor t
lybef orean
exposur ei sexpect ed,asi ntheadmi nistrat
ionofi mmune
globuli
nt opr eventv ir
al hepat i
tisA).
Breastfeedi ngi sanexampl eofani nt erventionthatact sat
all
threelevel sofpr i
mar ypr event i
on:
Healthpr omot ion:bypr ovidingopt i
mal nut r
it
ionf ora
youngchi ld,eitherast hesol edi etupt of ourmont hsof
age, orasasuppl ementi nlatermont hs.
Prev ent i
onofexposur e:byr educi ngexposur eoft he
childtocont ami nat edmi l
k.
Prev ent i
onofdi seaseaf terexposur e:byt hepr ovi
sion
ofant i-i
nf ecti
vef act ors,incl
udi ngant ibodies,whi t
eblood
cells,andot hers.
b.Secondar ypr ev ent i
on:
Aftert hebi ological onsetof
disease, butbef oreper manentdamageset sin,wespeak
of
secondar ypr event ion.Theobj ectiveher eistost opor
slow
thepr ogr essionofdi seasesoast opr eventorlimi t
per manent
damage, throught heear lydetect i
onandt reatmentof
disease.
(e.g.br eastcancer( preventionoft hei nvasivest ageoft he
disease) , tr
achoma( preventi
onofbl indness),andsy philis
(prevent ionoft ertiar yorcongeni t
al syphil
is))
c.Ter tiarypr event ion:
Afterper manentdamagehasseti n,
theobj ect iveoft ertiarypr ev
ent ionist oli
mi tthei mpactof
that
damage.
Thei mpactcanbephy si
cal,psy chological,social
(social stigmaorav oidancebyot hers),andf i
nanci al
.
Rehabi li
tationr efer st ot heretrai
ningofr emai ning
funct ions
formaxi mum ef f
ect i
v eness, andshoul dbeseeni navery
broadsense, notsi mpl yl i
mitedtot hephy sical aspect
.
Thus
thepr ov i
sionofspeci aldisabil
itypensionswoul dbea
form of
terti
ar ypr ev ention.
2.7Communi cabl eDi seaseCont rol
Thisr eferst ot her educt i
onoft heincidenceand
prev alenceof
communi cabl edi seaset oal evelwher eitcannotbea
maj or
publ i
cheal thpr oblem.
Met hodsofCommuni cableDiseaseCont rol
Ther ear ethr eemai nmet hodsofcont roll
ing
communi cabl e
diseases:
1.El i
mi nationoft heReser voir
a.Manasr eser voi r
:Whenmani st hereserv oir,
eradi cat i
on
ofani nf ectedhosti snotav i
ableopt i
on.Inst ead,the
foll
owi ng
optionsar econsi dered:
Det ect i
onandadequat etreatmentofcases:
arrest st hecommuni cabi l
it
yoft hedisease( e.g.Treat
ment
ofact i
vepul monar ytubercul osi s).
Isol ation:separ ationofi nfect edper sonsforaper iodof
communi cabili
tyoft hedi sease.I solat
ionisi ndi cat edfor
i
nf ectiousdi seasewi ththef ol l
owi ngfeatures:
Hi ghmor bidityandmor tality
Hi ghi nfectivity
Quar ant ine:l i
mi t
at i
onoft hemov ementofappar ent l
ywell
per sonorani mal whohasbeenexposedt ot hei nf ecti
ous
diseasef oradur ati
onoft hemaxi mum incubat ionper iod
oft hedi sease.
b.Ani mal sasr eser voir
:Act ionwi l
lbedeter mi nedbyt he
usef ulnessoft heani mals, howi ntimatel
yt heyar e
associ at ed
tomanandt hef easi bi
li
tyofpr ot ectingsuscept ible
animal s.
Forexampl e:
Pl ague: Ther atisregar dedasapestandt he
obj ective
woul dbet odest royther atandexcl udei tfrom human
habi tation.
Rabi es: Petdogscanbepr ot ectedbyv acci nat i
onbut
straydogsar edest r
oy ed.
I nfect edani mal susedf orf oodar eexami nedand
dest royed.
c.Reser voirinnon- l
ivi
ngt hings:Possi bl
et ol imi tman’ s
exposur et ot heaf fectedar ea( e.g.Soi l
,wat er, f
or est,etc.
).
2.I nterrupt ionoft ransmi ssi on
Thi sinv olv est hecont rolofthemodesoft r
ansmissi
on
from
ther eser v oirtot hepot enti
al newhostt hrough:
I mpr ov ementofenv i
ronment al sani t
ationand
per sonal
hy giene
Cont rol ofv ectors
Di si
nf ect ionsandst eri
li
zat i
on
3.Pr otect i
onofsuscept iblehost :Thi scanbeachi eved
through:
Immuni zat ion:Act iveorPassi ve
Chemo- prophy laxis-(e.g.Mal ar ia,meni ngococcal
meni ngitis, etc.)
Bet ternut ri
t i
on
Per sonal protection.(e.g.wear ingofshoes, useof
mosqui t
obednet ,insectr epellent s,etc.)
Rev i
ewQuest ions
1.St atet hesi xi mpor tantf actorst hati nvolvethechainof
communi cabl edi seasest r
ansmi ssi on.
2.Descr ibet het hreel evelsofdi seasepr eventi
on.
3.Whatar et hemet hodsusedt ocont rolcommuni cable
Diseases
CHAPTERTHREE
ORAL- FECALTRANSMI TTED
DI SEASES
3.1Lear ningObj ect i
v es
Att heendoft hischapt er,student swillbeablet o:
I dent i
fyt hef i
vei mpor tant“ Fs”inor al
-f
ecal disease
transmi ssion.
 St atedi seasest ransmi ttedmai nlyinwat erandi nsoil
.
 Li stdiseasescommonl ytransmittedbyhav i
ngdi r
ect
cont actwi t
hf eces.
Par ti
cipat eint hedi agnosi sandt reatmentofcases.
I mpl ementpr ev ent iveandcont rolmet hodsofor al
-
fecal
transmi t
teddi seases.
3.2I ntroduct i
on
Whatt hedi seasesi nt hisgr ouphav eincommoni sthat
the
causat i
veor ganismsar eexcr et
edi nthest ool
sofi nf
ected
per sons( or, rarely
, animal s) .Thepor talofentryf orthese
diseasesi st hemout h.
Ther efore, thecausat iv eorgani smshav etopasst hrough
the
envir
onmentf rom thefecesofani nf ectedper sont ot he
gastro-
intesti
nal t
ractofasuscept i
bl eper son.Thi sis
known
asthef ece-oraltr
ansmi ssi
onroute.Or al
-oraltransmi ssion
occursmost l
yt hr
oughunappar entf ecal contami nationof
food,wat erandhands.
Asindicat edi
nt heschemat i
cdiagram bel ow, foodt akesa
centralpositi
on; i
tcanbedi r
ectl
yori ndirectl
y
contami nated
viapoll
ut edwat er
,dir
tyhands,cont ami natedsoi l,orf l
ies.
Water

Fig.3.1Thef i
ve“ Fs”whi chplayanimpor tantr
oleinfecal
oraldiseasest ransmi ssion(fi
nger,f
li
es,food,fomitesand
fl
uid).
3.3FecesMai nl yinWat er
Thedi seasesi nt hisgroupar emainl
ytransmi t
tedthrough
fecall
ycont aminat edwat err
athert
hanf ood.
3.3.1Ty phoidfev er
Defini
tion
Asy stemici nf
ect iousdiseasecharacteri
zedbyhi gh
cont inuousf ever ,mal aiseandi nvolvementofl ymphoid
tissues.
Inf ecti
ousagent
Sal monel l
aty phi
Sal monel l
aent er i
tidis( rarecause)
Epi demi ology
Occur rence-I toccur swor ldwi de,par t
icularl
yinpoor
soci oeconomi c
ar eas.Annual i
nci dencei sest imat edatabout17
mi lli
oncaseswi thappr oximat ely600,000deat hs
wor l
dwi de.In
endemi careast hedi seasei smostcommoni npreschool
and
school agedchi ldr en(5- 19y earsofage)
Reser voir-Humans
Modeoft ransmi ssion-Bywat erandf oodcont aminated
by
fecesandur ineofpat ient sandcar r
iers.Fli
esmayi nfect
foodsi nwhi cht heor gani smst henmul t
iplytoachievean
i
nf ect i
vedose.
Incubat i
onper iod–1- 3weeks
Per i
odofcommuni cabi li
ty-Asl ongast hebacill
iappearin
excr eta, usuallyf rom t hef irstweekt hroughout
conv al
escence.About10%ofunt reatedpat i
entswi l
l
dischar gebaci l
li for3mont hsaf teronsetofsy mptoms,
and
2%- 5%becomechr oni ccar ri
er s.
Suscept ibili
tyandr esistance-
Suscept ibili
tyisgener alandi ncr easedi ni
ndi vidual swith
gast ri
cachl orhydriaort hosewhoar eHI Vposi ti
ve.
Relat i
vespeci fi
cimmuni tyf oll
owsr ecoveryf rom cl ini
cal
disease, unappar enti nfect i
onandact i
veimmuni zat i
onbut
i
nadequat et oprot ectagai nstsubsequenti ngest ionof
l
ar genumber sofor gani sms.
Clinicalmani f
estat i
on
Firstweek-Mi l
dill
nesschar act eri
zedbyf ev err i
sing
stepwi se
(l
addert y pe),anorexi a,l
et hargy ,malaiseandgener al
aches.
Dul landcont i
nuousf rontal headachei spromi nent .Nose
bleeding, vagueabdomi nal pai nandconst ipationi n10%of
pat i
ents.
Secondweek-Sust ainedt emper ature(fever).Sev er e
i
ll
ness
withweakness, ment aldul l
nessordel ir
ium, abdomi nal
discomf or tanddi stension.Di arrheaismor ecommont han
fi
rst
weekandf ecesmaycont ainbl ood.
Thi r
dweek-Pat i
entcont inuest obef ebril
eand
i
ncr easingly
exhaust ed.I fnocompl i
cat i
onsoccur ,patientbegi nst o
i
mpr oveandt emper aturedecr easesgr adual l
y.
Clinicalmani fest ationssuggest iveoft yphoi df ever
Fev er -Sust ainedf ev er(ladderf ashion)
Rosespot s-Smal l pallor, blanching, sli
ght l
yraised
macul esusual lyseenonchestandabdomeni nthe
fi
rst
weeki n25%ofwhi tepeopl e.
 Rel ativebr ady cardia-Sl owert hanwoul dbeexpect ed
from t hel ev el oftemper atur e.
 Leucopoeni a-Whi tecel lcounti slesst han
4000/ mm3of
blood.
Diagnosi s
Basedoncl i
nical gr oundsbutt hisi sconf usedwi th
wi de
var i
et yofdi seases.
Wi dal react ionagai nstsomat i
candf lagellarantigens.
Bl ood, fecesorur inecul ture.
Treat ment
1.Ampi cil
linorco- t
r i
moxazol ef orcar r
iersandmi ldcases.
2.Chl or ampheni col orci profloxaci norcef tr
iaxonef or
seriousl yi l
lpat ient s.
Nur singcar e
1.Mai ntainbodyt emper aturet onor mal .
2.Appl ycomf ortmeasur es.
3.Fol l
owsi deef fect sofdr ugs.
4.Moni t
orv i
tal signs.
5.Fol
l
owst
ri
ctl
yent
eri
cpr
ecaut
ions:

washhands
weargl ov es
t eachal lper sonsaboutper sonal hygiene
6.Obser vet hepat ientcl osel yforsignandsy mpt omsof
bowel per for ation
er osionofi nt est i
nal ulcers
suddenpai ni nt hel owerr ightsideoft heabdomen
abdomi nal r i
gi dity
suddenf alloft emper atureandbl oodpr essure
7.Accur atelyr ecor di ntakeandout put.
8.Providepr operski nandmout hcar e.
Preventionandcont rol
1.Treatmentofpat ientsandcar riers
2.Educat iononhandwashi ng,par ti
cularl
yf oodhandlers,
pati
entsandchi ldcar egiver s
3.Sanitarydi sposal offecesandcont r
ol offl
ies.
4.Provisionofsaf eandadequat ewat er
5.Safehandl ingoff ood.
6.Exclusionoft yphoi dcar riersandpat i
ent sfrom handl
ing
of
foodandpat ient s
7.Immuni zationf orpeopl eatspeci al ri
sk( e.
g.Traveler
s
to
endemi car eas)
8.Regularcheck-
upoff
oodhandl
ersi
nfoodanddr
inki
ng
establ
i
shment s

Baci ll
ar yDy sent ery( Shi gellosis)
Def init
ion
Anacut ebact eri
al diseasei nvolvi
ngt helar
geanddi stal
smal l
i
nt estine, causedbyt hebact eri
aoft hegenusshi gel
la.
Infect i
ousagent
Shi gell
ai scompr isedoff ourspeci esorserotypes.
Gr oupA=Shi gell
ady sent raie( mostcommoncause)
Gr oupB=Shi gel l
af lexner i
Gr oupC=Shi gell
aboy dii
Gr oupD=Shi gell
asonnei
Epi demi ology
Occur rence-I toccur swor ldwide, andisendemi cinboth
tropical andt emper atecl i
mat es.Outbreakscommonl y
occur
undercondi tionsofcr owdi ngandwher eper sonalhygi
ene
i
s
poor ,suchasi njail
s, insti
tut i
onsf orchil
dren,daycare
cent ers, ment al hospi talsandr efugeecamps.I tis
est i
mat ed
thatt hedi seasecauses600, 000deat hspery earint
he
wor ld.
Two- thi
r dsoft hecases, andmostoft hedeaths,arei n
childrenunder10y earsofage.
Reser voir-Humans
Modeoft ransmi ssion-Mai nl
ybydi rectorindir
ectf ecal-
oral
transmi ssionf r
om apat i
entorcar ri
er.Transmission
through
wat erandmi l
kmayoccurasar esul
tofdi r
ectfecal
cont ami nat i
on.Fliescant ransferorganismsf rom latri
nes
toa
non- refrigeratedfoodi tem inwhi chorganismscansur vive
and
mul tiply.

Incubationperi
od-12hour s-4day s(usually1-3days)
Periodofcommuni cabil
it
y-Dur i
ngacut einfecti
onand
until
theinfecti
ousagentisnol ongerpr esentinfeces,usual
ly
withinfourweeksaf t
eril
lness.
Suscept i
bil
it
yandr esi
stance-Suscept ibi
li
tyisgeneral.
The
diseaseismor esevereiny oungchi l
dren,theelder
lyand
the
mal nouri
shed.Breast-
feedingisprotectiv
ef orinf
antsand
youngchi ldren.
Cli
nicalMani festat i
on
Fev er, rapidpul se,vomi ti
ngandabdomi nalcrampare
promi nent .
Di arrheausual l
yappear saf t
er48hour swith
dysent ery
super veni ngt woday slater.
 Gener ali
zedabdomi naltenderness.
Tenesmusi spr esentandf ecesarebloody ,
mucoid
andof
smal lquant ity.
Dehy drat i
oni scommonanddanger ous-i tmaycause
muscul arcr amp, oli
guri
aandshock.
Diagnosi s
Basedoncl inicalgrounds
St ool mi croscopy( presenceofpuscel l
s)
St ool cultureconf ir
mst hediagnosis
Treatment
1.Flui
dandel ectrolyter
epl acement
2.Co-tri
moxazol einsev ereecasesorNal idixi
cacidint
he
caseofr esi stance.

Preventi
onandcontrol
1.Detecti
onofcar
ri
ersandt r
eat
mentofthesickwi
l
l
i
nter
r uptanepi
demic.
2.Handwashingaft
ertoi
letandbef
orehandl
i
ngoreati
ng
food.
3.Pr operexcr etadi sposal especi al
lyfrom pati
ents,
conv alescentandcar ri
ers.
4.Adequat eandsaf ewat ersuppl y.
5.Cont rol offl
ies.
6.Cl eanl i
nessi nf oodhandl i
ngandpr eparation.
Amoebi asi s(Amoebi cDy senter y
)
Def inition
Ani nfect ionduet oapr otozoanpar asitethatcauses
i
nt est i
nal
orext ra-intestinaldisease.
Infect iousagent
Ent amoebahi stolyti
ca
Epi demi ology
Occur rence-wor l
dwi debutmostcommoni nthetropics
and
sub- tropi cs.Pr evalentinar easwi thpoorsani tati
on,in
ment al
i
nst itutionsandhomosexual s.Invasiveamoebi asi
sis
most lya
diseaseofy oungpeopl e(adults).Rarebelow5y earsof
age,
especi allybelow2y ears.
Modeoft ransmi ssion–Fecal -
oral t
ransmissionby
i
ngest ion
off oodorwat ercont aminatedbyf ecescont ai
ningthe
cy st.
Acut eamoebi cdy senteryposesl i
mi teddanger.
Incubat ionper iod-Var i
ablefrom fewday stosev er
al
mont hs
ory ear s; commonl y2-4weeks.
Per iodofcommuni cabil
ity-Dur
ingt heperi
odofpassi ng
cy stsofE.hi stolytica,whi chmaycont i
nueforyears.
Suscept ibil
ityandr esi
stance-Suscept ibi
l
ityisgeneral
.
Suscept i
bilitytor einfectionhasbeendemonst r
atedbutis
appar ent l
yr are.
TRANSMI SSI ON
1.Cy st si ngest edi nf ood, water
orf rom handscont ami natedwithf eces.
ENVI RONMENT
6.Fecescont ainingi nfecti
vecysts
cont ami nat etheenv i
ronment .
HUMANHOST
2.cy st sexcy st, f
or ming
trophozoi t
es
3.Mul tiplyi nintest ine
4.Tr ophozoi tesency st.
5.I nf ect i
v ecy stspassedi n
feces. *t rophozoi tespassedi nfeces
disint egr at e.
Clini calMani fest ation
St artswi thapr odormal epi
sodeofdi arrhea,
 abdomi nal
cramps, nausea, vomi tingandt enesmus.
Wi thdy sent ery,fecesar egenerall
ywat ery
,cont
aini
ng
mucusandbl ood.
Diagnosi s
Demonst rationofet amoebahi stolyti
cacystor
trophozoi te
i
nst ool .
Treat ment
1.Met roni dazol eorTi nidazole
Prev ent i
onandcont r
ol
1.Adequat et reatmentofcases
2.Pr ov i
si onofsaf edr inkingwat er
3.Pr operdi sposal ofhumanexcr et
a( f
eces)and
handwashi ngf ollowi ngdef ecati
on.
4.Cl eani ngandcooki ngofl ocalfoods(e.g.raw
veget ables)
toav oi deat ingf oodcont ami natedwithfeces.
Giardi asis
Def i
ni ti
on
Apr ot ozoani nfectionpr incipall
yoftheuppersmal l
i
nt estine
associ at edwi t
hsy mpt omsofchr onicdiarr
hea,
steat orrhea,
abdomi nal cr amps, bloating,fr
equentlooseandpal e
greasy
stool s, fatigueandwei ghtloss.
Infect iousagent
Giardi al ambl ia
Epidemi ology
Occur rence-Wor ldwidedi stri
bution.Chi ldrenar emor e
affect edt hanadul t
s.Thedi seaseishi ghl ypr eval
entin
areas
ofpoorsani tati
on.
Reser v oir-Humans
Modeoft ransmi ssion-Per sont oper sont r
ansmi ssi
on
occur sbyhandt omout htransferofcy stsf rom fecesof
an
i
nf ect edi ndiv i
dual especiallyininsti
tutionsanddaycar e
cent er s.
Per i
odofcommuni cabil
it
y -Entir
eper iodofi nfection,
often
mont hs.
Suscept ibili
tyandr esi
stance-Asy mpt omat iccarrierrat
e
i
s
high.I nf ect i
onisf requentlysel f
-l
imited.Per sonswi t
hAI DS
mayhav emor eser iousandpr olongedi nfection.
ClinicalMani festation
Rangesf r
om asy mptomat i
cinfectiont osev erefail
ure
to
thriveandmal -absor pti
on.
Youngchi ldrenusual lyhav ediarrheabutabdomi nal
distensionandbl oatingarefrequent
.
TRANSMI SSI ON
1.Cy stsingest edi nfood,
wat erorf rom hands
cont ami natedwi thf eces.
ENVI RONMENT
6.Fecescont aining
i
nf ect i
vecy st s
cont ami natet he
env i
ronment .
HUMANHOST
2.cy stsexcy st,
formi ng
trophozoi tes
3.Mul ti
plyini ntest i
ne
4.Tr ophozoi tes
ency st.
5.Inf ecti
vecy sts
passedi nf eces.
*t r
ophozoi tespassedi nfeces
disintegrate.
Adul t
shav eabdomi nalcramps,di
arrhea,
anor exi
a,
nausea, mal aise, bloati
ng, manypati
entscompl ainof
sulphurt est ing( belching).
Diagnosi s
Demonst rationofGi ardi
al ambl
i
acy stortrophozoit
e
 in
feces.
Treat ment
1.Met roni dazol eorTi nidazole
Prev entionandcont rol
1.Goodper sonal hy
giene, andhandwashi ngbef or
ef ood
andf ollowi ngt oil
etuse
2.Sani tarydi sposal off eces
3.Pr otectionofpubl icwat ersupplyfrom contaminationof
feces
4.Caset reatment
5.Saf ewat ersuppl y
Chol era
Def i
nition
Anacut eillnesscausedbyanent erot
oxinelaboratedby
vibri
o
cholerae.
Infectiousagent
Vibriochol erae
Epidemi ol
ogy
Occur rence-hasmadeper i
odicoutbr
eaksindi f
ferent
partsof
thewor ldandgi venr i
set opandemi cs.Endemi c
predomi nantlyi nchil
dr en.
Reser voir-Humans
Modeoft ransmi ssi
on-byi ngesti
onoff oodorwat er
directly
ori ndirectl
ycont ami natedwi thfecesorv omi tusof
i
nf ected
per son.
Incubat i
onper i
od-f rom af ewhour st o5day s,usual l
y2-3
day s.
Per iodofcommuni cabili
ty-forthedur ati
onoft hest ool
posi ti
vest age, usual lyonlyaf ewday safterrecov ery.
Ant ibi
ot i
csshor tent heper i
odofcommuni cabil
ity
.
Suscept ibil
it
yandr esistance-Variable.Gast ri
c
achl orhy dr
ia
i
ncr easesr i
skofi l
lness.Br east-f
edi nfantsarepr otected.
Cl i
nicalMani festat i
on
Abr uptpai nlesswat erydiarr
hea; thediarrheal ooks
li
ke
ricewat er.
I nsev erecases, severall
iter
sofl iqui
dmaybel ostin
few
hour sleadi ngt oshock.
Sev erelyillpatientsar ecyanotic,havesunkeney es
and
cheeks, scaphoi dabdomen, poorski nt ur
gor ,andt hready
orabsentpul se.
Lossoff luidcont i
nuesf or1-7day s.
Di agnosi s
Basedoncl inical gr
ounds
 Cul tur e( stool)conf irmat ion
Treat ment
Promptr epl acementoff luidsandel ectrol
ytes
Rapi dI Vi nfusionsofl argeamount s
I sot oni csal inesol utionsal ternati
ngwi t
hisotonic
sodi um
bicarbonat eorsodi um lact ate.
Ant i
bi ot i
csl i
ket etracy cl
inedr amat i
callyreducethe
durat ion
andv ol umeofdi arrhear esultinginear lyeradicati
onof
vibri
ochol erae.
Nur singcar e
1.Weargownandgl ove.
2.Washy ourhands.
3.Moni torout puti ncludingst ooloutput .
4.Pr ot ectt hepat i
entf ami lybyadmi nisteri
ngTet r
acycli
ne.
5.Heal theducat ion.
Prev ent ionandcont rol
1.Caset reat ment
2.Saf edi sposal ofhumanexcr etaandcont roloffl
ies
3.Saf epubl i
cwat ersuppl y
4.Handwashi ngandsani taryhandl i
ngoff ood
5.Cont rol andmanagementofcont actcases
Infect ioushepat itis
(Viralhepat i
tisA, Epi demi chepat iti
s, typeAhepat iti
s)
Def i
ni tion
Anacut ev i
ral diseasechar acter
izedbyabr uptonsetof
fever,
mal aise,anor exia,nauseaandabdomi naldiscomfor
t
fol
lowed
wit
hi naf ewday sbyj aundice.
Inf
ect iousagent
Hepat iti
sAv irus
Epidemi ology
Occur rence-Wor l
dwidedi str
ibuti
oninspor adicand
epi
demi c
for
ms.I ndev el opingcount ri
es,adul
tsar eusuall
yimmune
and
epi
demi csofHAar euncommon.I nfecti
oni scommon
wher e
environment al sanit
ationispoorandoccur satanearly
age.
Reser voir-Humans.

Modeoft ransmi
ssion-Persont opersonbyf ecal-
oral
route.
Throughcontaminatedwaterandf oodcontami natedby
i
nfectedfoodhandlers.
I
ncubat i
onperi
od-15- 55days,aver
age28-30day s.
Periodofcommuni cabil
it
y-Highduringthelaterhalfof
the
i
ncubat i
onper i
odandcont i
nuingf orf ewday sfollowi ng
onset
ofjaundice.Mostcasesar enon- infect i
ousf oll
owi ngf i
rst
week
ofjaundice.
Suscept i
bi l
it
yandr esistance-Suscept ibili
tyisgener al.
Immuni tyf ol
lowi ngi nfect i
onpr obabl ylast sf orli
f e.
Cli
nicalmani festation
Abruptonsetoff ev er,mal ai
se, anor exia,nauseaand
abdomi nal discomf ort,foll
owedi nf ewday sbyj aundi ce.
Compl eter ecov erywi thoutsequel orr ecur r
enceasa
rul
e.
Diagnosis
Basedoncl i
nical andepi demiologi cal ground
Demonst rationofI gM ( IgM anti-HAV)i nt heser um of
acutelyorr ecent lyil
l patients.
Treatment
Sympt omat i
c: Rest,hi ghcar bohydr atedi etwi t
hl owf at
and
protei
n.
Preventionandcont rol
1.Publiceducat i
onaboutgoodsani tationandper sonal
hygiene,wi thspeci al emphasi soncar ef ulhandwashi ng
andsani tarydi sposal offeces.
2.Properwat ertreatmentanddi stributionsy stemsand
sewagedi sposal .
3.Pr opermanagementofdaycar ecent erst omi ni
mi ze
possi bilityoff ecal-
oraltransmi ssion.
4.HAv acci nef oralltr
av el
erst ointermedi ateorhi ghly
endemi car eas.
5.Pr otect ionofdaycar ecent ers’empl oy eesbyv accine.
FecesMai nl yinSoi l
Thedi seasesi nthiscat egor yaremai nl yt ransmi tt
ed
through
fecal cont ami nationofsoi l
.Thesei nfect i
onsar eacquired
throughman’ sexposur et of ecall
ycont ami nat edsoil
.
Ascar iasi s
Def i
nition
Ahel mi nthi cinfectionoft hesmal lintest i
negener all
y
associ at edwi thf ewornosy mpt oms.
Infectiousagent
Ascar isl umbr icoides.
Epidemi ology
Occur r ence-Themostcommonpar asi teofhumanswher e
sanitat ioni spoor .School chi l
dren( 5-
10y earsofage)ar e
mostaf fect ed.Hi ghlyprev alentinmoi stt ropicalcountries
Reser v oi r
-Humans; ascarideggsi nsoi l.
Modeoft r ansmi ssion-I ngestionofi nf ectiveeggsf r
om
soil
contami nat edwi thhumanf ecesoruncookedpr oduce
contami nat edwi thsoi l
cont aininginfect iveeggsbutnot
dir
ect lyf rom per sont oper sonorf r
om f reshf eces.
Incubat i
onper i
od-4- 8weeks.
Per i
odofcommuni cabilit
y-Asl ongasmat urefer
ti
li
zed
femal ewor msl i
vei nthei ntestine.Usual l
i
fespanoft he
adul t
wor mi s12mont hs.
Suscept ibil
it
yandr esi stance-Suscept ibil
i
tyisgeneral.
LifeCy cl
e
Transmi ssionandl ifecy cleofAscar islumbricoi
des.
ClinicalMani f
estation
Mosti nfecti
onsgounnot icedunt i
llargewor mis
passedi n
fecesandoccasi onallyt hemout handnose.
Mi grantlarvaemaycausei tching,wheezingand
dyspnea,
fever, coughpr oduct i
v eofbl oodysput um mayoccur .
TRANSMI SSION
1.Inf ecti
v eeggsi ngest edin
foodorf rom cont ami nated
hands
ENVI RONMENT
6.Eggsbecomei nfect i
v e
(embr yonated)insoi lin30- 40
day s.
7.Inf ecti
v eeggscont ami natethe
env i
ronment .
HUMANHOST
2.Lar v aehat ch.
Migr atet hr oughl i
verandl ungs.
3.Passupt r
acheaandar eswal l
owed
4.Becomemat urewor msi nsmall
i
ntest ine
5.Eggspr oducedandpassedi n
feces.
Abdomi nal painmayar isefrom int
esti
nalorduct
(bi
liary ,
pancr eat ic)obst ruction.
Ser iouscompl i
cat i
onsi ncl
udebowel obstructi
onduet o
knot ted/ intertwinedwor ms.
Diagnosi s
Mi croscopi cidentifi
cat ionofeggsi nastool sample
Adul twor mspassedf rom anus, mouthornose.
Treat ment
1.Al bendazol eor
2.Mebendazol eor
3.Pi per azineor
4.Lev ami sole
Prev ent ionandcont rol
1.Tr eat mentofcases
2.Sani tarydi sposal off eces
3.Pr ev entsoi lcontami nationinar easwherechi l
drenpl
ay
4.Pr omot egoodper sonal hygi
ene( handwashing).
Trichur iasi s
Def i
nit
ion
Anemat odei nfect i
onoft hel argei ntesti
ne, usual ly
asy mpt omat icinnat ure.
Infect i
ousagent
Tr i
chur ist ri
chur i
a( whi pwor m)
Epi demi ol ogy
Occur r
ence-Wor ldwide, especi all
yi nwar m moi str egions.
Commoni nchi l
dr en3- 11y ear sofage.
Reser v
oi r-Humans
Modeoft r
ansmi ssion-I ndi rect,par ti
cularlythr
oughpi ca
or
i
ngest i
onofcont ami nat edv eget abl es.Noti mmedi ately
transmi ssiblef r
om per sont oper son.
Incubat i
onper i
od-I ndef inite
Per iodofcommuni cabi l
ity-Sev er alyearsi nunt reat ed
car ri
ers.
Suscept i
bilit
yandr esi stance-Suscept i
bil
ityisuni versal.
LifeCy cle
Tr ansmi ssionandl ifecy cl eofTr ichur i
st r
ichuria.
Clinicalmani festation
Sever it
yi sdirectlyr elatedt othenumberofi nf ecting
wor ms.
Mosti nfectedpeopl ear easy mpt omat ic.
Abdomi nal pain,tiredness, nauseaandv omiting,
diar r
hea
orconst ipat i
onar ecompl aintsbypat i
ents.
 Rect alprolapsemayoccuri nheavi
l
yinf
ect
edv
ery
young
chil
dr en.
TRANSMI SSI ON
1.Inf ecti
veeggsi ngestedi nfood
orfrom cont aminatedhands
ENVI RONMENT
6.Eggsbecomei nf
ect i
ve
(embr yonated)insoilafter3
weeks.
7.Inf ecti
veeggscont ami nat
ethe
env i
ronment
HUMANHOST
2.Lar vaehat ch.
Dev elopi nsmal li
ntesti
ne.
Migr atet ocaecum.
3.Becomemat urewor ms.
4.Eggspr oducedandpassed
i
nf eces.
Diagnosi s
Demonst r
ati
onofeggsi nfeces.
Treat ment
1.Al bendazol eor
2.Mebendazol e
Prev ent i
onandcont rol
1.Sani tarydisposal offeces
2.Mai nt aininggoodper sonal hygiene( i
.e.washi nghands
andv eget ablesandot hersoi lcont ami nat edf oods)
3.Cut tingnai l
sespeci allyinchi l
dren
4.Tr eat mentofcases.
Pol iomy elitis
Def inition
Av iral inf ect i
onmostof tenrecogni zedbyt heacut eonset
of
flacci dpar alysi
s.
Infect iousagent
Pol i
ov iruses( t
ypeI ,I
IandI I
I)
Epi demi ology
Occur rence–Wor ldwi depr i
ort otheadv entof
i
mmuni zat ion.
Casesofpol i
ooccurbot hspor adicallyandi nepi demi cs.
Pr i
mar ilyadi seaseofi nfantsandy oungchi ldren.70- 80%
of
casesar el esst hant hreey earsofage.Mor ethan90%of
i
nf ect ionsar eunappar ent .Flaccidpar al
y sisoccur si nless
than1%ofi nfecti
ons.
Reser v oi r–humans, especi all
ychi ldren
Modeoft ransmi ssion-Pr imar i
lyper son- to-person, spread
pr i
nci pal lyt hrought hef ecal-
or alr
out e.I
nr areinstances,
mi l
k,
foodst uf fsandot hermat eri
alscont ami nat edwi thfeces
hav e
beeni ncriminatedasv ehi cles.
Incubat ionper i
od-commonl y7- 14day s
Per iodofcommuni cabi l
ity–notpr eciselyknown, but
transmi ssi onispossi bleasl ongast hev irusi sexcr eted.
Suscept i
bi li
tyandr esistance-Suscept ibi
lityiscommoni n
chi ldrenbutpar al y
sisrar elyoccur s.Infectionconf ers
per manenti mmuni ty.
Clini calmani festation
Usual lyasy mpt omat icornon- specif i
cfev eris
mani fest ed
i
n90%ofcases.
I
fi tprogr essest omaj ori l
lness, sev eremuscl epai n,
stiff
neckandbackwi thorwi thoutf lacci dparal ysismayoccur .
Par alysisisasy mpt omat icandoccur swi thi
nthr eet o
four
day sofi llness.
Thel egsar emor eaf f
ect edt hanot herpar tofthebody .
Par alysisofr espiratoryandswal lowingmuscl esi s
l
ifet hreat ening.
Diagnosi s
Basedoncl inicalandepi demi ologicalgr ounds
Tr eat ment
Sy mpt omat i
c
Pr ev entionandcont r
ol
1.Educat epubl icaboutt headv ant ageofi mmuni zat i
onin
earl
ychi ldhood.
2.Triv
alentl i
veat tenuat
edv accine(OPV)atbirt
h.
3.Safedi sposal ofhumanexcr et a(f
eces).
ReviewQuest i
ons
1.Whatdoesf ecal-or
altr
ansmi ssionmean?
2.Ment i
onsomeoft hediseasest r
ansmittedt
hrough
unappar entfecal contaminati
onoff ood,waterand
hands.
3.Statesomeoft hecommonpr eventi
veandcontrol
measur esofor al
-fecalt
ransmitteddiseases.
CHAPTERFOUR
AI R-BORNEDI SEASES
4.1Lear ningObjecti
ves
Att heendoft hi
schapt er,studentswi l
lbeablet o:
-Li stcommonai r-
bornedi seases.
-Ident i
fythecommonmodesofai r-bornediseases
transmi ssion.
-Par ti
cipat ei
ndiagnosi sandt r
eatmentofcommon
airborne
diseases.
-Appl ypr eventi
veandcont r
ol methodsf orair
-borne
diseases.
Introduct i
on
Theor ganismscausi ngt hediseasesi ntheair-
bornegroup
ent erthebodyv iather espir
atorytract.Whenapat i
entor
car ri
erofpat hogenst al
ks,coughs, laughs,orsneezes,
he/ she
dischar gesf lui
ddr opl ets.Thesmal lestoft heser emainup
i
n
theai rforsomet imeandmaybei nhal edbyanewhost .
Dr opletswi thasi zeof1- 5mi cronsar equiteeasi l
ydrawn
i
nt o
thel ungsandr et ai
nedt here.
Dr opletsthatar ebi ggeri nsi zewi llnotr emai nair-
bornefor
l
ongbutwi l
lfalltothegr ound.Her e, howev er,theydryand
mi xwi thdust .Whent heycont ainpat hogenst hatareable
to
sur vi
vedr ying,thesemaybecomeai r-borneagai nbywi nd
or
somet hingst ir
ri
ngupt hedust ,andt heycant henbe
i
nhal ed.
Air-bornedi seases, obv i
ousl y,willspr eadmor eeasily
when
therei sov ercrowdi ng, asi nov ercrowdedcl assr ooms,
publ i
c
transpor t,canteens, dancehal l
s, andci nemas.Good
vent i
lati
oncandomucht ocount er actt heeffectsof
ov ercrowdi ng.Ai r-
bor nedi seasesar emost lyacquired
through
ther espiratorytract .
CommonCol d( Acut eVi ralRhi ni
t i
sor
Cor yza)
Def initi
on
Anacut ecat arrhal i
nf ect i
onoft heupperr espir
atoryt r
act.
Infect i
ousagent
Rhi nov iruses( 100ser otypes)ar ethemaj orcausesi n
adul ts.
Par ainfluenzav iruses, respirator ysyncytialvir
uses( RSV) ,
Influenza, andAdenov irusescausecommoncol d-l
ike
i
llnessesi ni nfant sandchi ldren.
Epi demi ology
Occur rence-Wor ldwi debot hi nendemi candepi demi c
forms.
Manypeopl ehav eonet osi xcol dspery ear.Greater
i
nci dencei nt hehi ghl ands.I ncidencei shi ghinchildren
under
5y ear sandgr adual lydecl i
neswi thincreasingage.
Reser voir-Humans
Modeoft ransmi ssion-bydi rectcont actori nhalati
onof
airbor nedr opl ets.Indi r
ect l
ybyhandsandar t
icl
esf reshly
soiledbydi schar gesofnoseandt hroatofani nfected
per son.
Incubat i
onper i
od-bet ween12hour sand5day s,usually
48
hour s, varyingwi ththeagent .
Per iodofcommuni cabilit
y-24hour sbef oreonsetandf or
5
day saf teronset .
Suscept ibili
tyandr esistance-Suscept i
bili
tyi
suniversal
.
Repeat edi nfect ions( attacks)aremostl ikel
yduet o
mul t
iplicity
ofagent s.
Cli
nicalMani fest at
ion
Cory za, sneezi ng,lacrimation,phar yngealornasal
i
rri
tation, chil
lsandmal aise
Dryorpai nful throat.
Diagnosi s
Basedoncl inical grounds
Treatment
1.Noef f ectivet reatmentbutsuppor t
ivemeasur esli
ke
Bedr est
Steam i nhal ation
Highf luidint ake
Anti pai n
Balanceddi eti ntake
Prevent ionandCont rol
1.Educat ethepubl i
caboutt heimpor tanceof :
Handwashi ng
Cov er i
ngt hemout hwhencoughi ngandsneezi ng
Sanitar ydi sposal ofnasal andoral dischar
ges
2.Av oidcr owdi nginl i
vingandsl eepingquar t
ersespecial
ly
i
ni nstitut i
ons
3.Prov ideadequat ev ent i
lat
ion
Measl es( Rubel la)
Def initi
on
Anacut ehi ghlycommuni cabl evi
r al di
sease
Infect i
ousagent
Measl esv irus
Epi demi ology
Occur rence-Pr i
ort owi despr eadimmuni zation,measles
was
commoni nchi ldhoodsot hatmor et han90%ofpeopl e
had
beeni nfect edbyage20; fewwentt hroughl i
f ewithoutany
attack.
Reser v oir-Humans
Modeoft ransmi ssion-Airbor nebydr opletspr ead,dir
ect
cont actwi thnasal orthroatsecr et i
onsofi nfectedpersons
and
l
esscommonl ybyar t
icl
esf r
eshlysol i
dwi t
hnoseand
throat
secr etion.Gr eat erthan94%her di mmuni tymaybeneeded
to
i
nt erruptcommuni tyt r
ansmi ssi
on.
Incubat i
onper iod-7- 18day sfrom exposur et oonsetof
fever .
Per iodofcommuni cabi l
it
y -sli
ghtlybef oret hepr odromal
per i
odt of ourday saftertheappear anceoft herashand
mi nimal aftertheseconddayofr ash.
Suscept ibilit
yandr esistance-Al lt hosewhoar e
nonvacci
nated
orhavenothadthediseasear
esuscept
ible.
Permanentimmunit
yisacquir
edaft
ernaturali
nfect
ionor
i
mmuni zat
ion.

ClinicalMani festation
Prodr omal fever,conjunct i
vit
is,cor
y za,coughand
Kopl ik
spot sont hebuccal mucosa
Achar acteristicredbl otchyrashappear sont hethirdt
o
sev enthday ,beginningont hef ace,graduallybecomi ng
gener al i
zed,lasting4- 7day s.
Leucopoeni ai scommon.
Compl icati
onsl i
keot i
tismedi a,pneumoni a,diar
rhea,
encephal i
tis,croup( Laryngot r
acheobr onchi t
is)may
resultf rom v i
ralreplicati
onorbact eri
al superinfecti
on.
Diagnosi s
Basedoncl inicalandepi demiologi
cal grounds
Treat ment
1.Nospeci fi
ct reatment
2.Tr eat mentofcompl icati
ons
3.Vi tami nApr ovisi
on
Nur singcar e
1.Adv isepat i
entt ohav ebedr est.
2.Rel iefoff ever.
3.Pr ov isionofnon- irr
itantsmal lfrequentdi et.
4.Shor tent hefingernails.
Prev ent ionandcont rol
1.Educat et hepubl i
caboutmeasl esi mmuni zati
on.
2.Immuni zationofal lchi l
dr en(lesst han5y earsofage)
whohadcont actwi thinf ect edchildr en.
3.Pr ov isionofmeasl esv acci neatni nemont hsofage.
4.Ini t
iatemeasl esv accinat ionat6mont hsofagedur i
ng
epidemi candr epeatat9mont hsofage.
Influenza
Def initi
on
Anacut ev iraldiseaseoft her espi ratorytract
Infectiousagent
Thr eet y pesofi nfl
uenz av irus(A, BandC)
Epidemi ology
Occur rence-I npandemi cs, epidemi csandl ocali
zed
out breaks.
Reser v oi r
-Humansar ethepr imar yr eservoir
sforhuman
i
nf ection.
Modeoft r ansmi ssion-Ai rbornespr eadpr edomi nat
es
amongcr owdedpopul ationsi ncl osedpl acessuchas
school
buses.
Incubat ionper i
od-shor t
, usually1- 3day s

Per
iodofcommuni
cabi
li
ty-3-
5day
sfr
om cl
i
nical
onseti
n
adults;upto7day siny oungchi ldren.
Suscept i
bili
tyandr esistance-whenanewsub- t
ype
appear s,
allchil
drenandadul tsar eequallysuscept i
ble.
Inf
ect i
onpr oducesimmuni tytot hespecificinfecting
agent .
Cli
nicalMani festat
ion
Fever,headache, may algia,prostrati
on,soret hroatand
cough
Coughi softensev ereandpr otr
act ed,
butot her
mani fest
ationsaresel f-
li
mi t
edwi t
hr ecoveryin2- 7day s
Diagnosis
Basedoncl ini
cal ground

Treatment
1.Sameascommoncol d,namely:
Anti-
painandant ipyret i
c
Highf l
uidintake
Bedr est
Balanceddi etintake
Preventionandcont rol
1.Educat et hepubl i
ci nbasi cpersonalhygi
ene,especi
all
y
thedangerofunpr otect edcoughsandsneezesandhand
tomucusmembr anet ransmi ssi
on
2.Immuni zati
onwi thav ail
ablekil
ledvi
rusvacci
nesmay
provide70- 80%pr otect ion.
3.Amant adizehydr ochl ori
dei sef
fecti
veinthe
chempr ophy laxisoft y
peAv ir
usbutnotot hers.
Dipht her i
a
Def i
nition
Anacut ebact erialdiseasei nv olvi
ngpr imar i
lytonsils,
phar ynx,
nose, occasi onal lyothermucusmembr anesorski nand
somet i
mest heconj unct i
v aorgeni t alia.
Infectiousagent
Cor ynebact erium di phther i
ae
Epidemi ology
Occur r
ence-Di seaseofcol dermont hsi nt emper at
ezones,
i
nv olvingpr i
mar ilynon- i
mmuni zedchi ldrenunder15y ears
of
age.I tisof tenf oundamongadul tpopul ati
ongr oups
whose
i
mmuni zat i
onwasnegl ected.Unappar ent,cutaneousand
wounddi pht her i
acasesar emuchmor ecommoni nthe
tropics.
Reser v oir-Humans
Modeoft ransmi ssion-cont actwi thapat ientofcar r
ier.i.
e.
wi t
hor al ornasal secret i
onsori nfect edski n.
Incubat i
onper i
od-usual ly2-5day s
Per i
odofcommuni cabi l
it
y-v ariable, unt il
v i
rulentbaci ll
i
hav edi sappear edf rom di schar gesandl esion; usuall
y2
weeksorl ess.
Suscept i
bili
tyandr esistance-Suscept ibil
ityisuni ver
sal .
Infantsbor net oimmunemot hersarer elat
ivelyimmune,
but
protectioni spassi v eandusual l
ylostbef ore6mont hs.
Recov eryf rom cl inical diseasei snotal way sfoll
owedby
l
ast i
ngi mmuni ty.Immuni t
yi sof t
enacqui r
edt hr
ough
unappar entinf ection.Pr ol
ongedact i
v eimmuni t
ycanbe
i
nducedbydi pht her i
at oxoi d.
Clini
calMani f est ation
Char acteristicl esionmar kedbyapat chorpat chesof
an
adher entgr ayishmembr anewi t
hasur r
oundi ng
i
nf l
ammat i
on( pseudomembr ane).
Throati smoder atel
ysor ei npharyngot onsill
ar
diphther i
a,
withcer v i
cally mphnodessomewhatenl argedandt ender
;
i
nsev erecases, ther eismar kedswel li
ngandedemaof
neck.
Lateef fectsofabsor ptionoft oxinappear i
ngafter2-6
weeks, includi ngcr anial andper i
pheral,mot orand
sensor yner vepal siesandmy ocardit
is( whichmayoccur
early)andar eof tensev ere

Di
agnosis
Basedoncli
nical
andepidemi
ologi
calgrounds
Bacter
iol
ogi
cexaminat
ionofdi
schargesfrom l
esi
ons.
Treat ment
1.Di pht heriaant itoxin
2.Er ythromy cinf or2weeksbut1weekf orcut aneous
form
or
3.Pr ocai nepeni cill
inf or14day sorsi ngledoseof
Benzat hin
penicillin
Primar ygoal ofant ibioticther apyf orpat i
entsorcar riersis
to
eradicat eC.di pht heriaeandpr eventt ransmissi onfrom
the
patientt osuscept iblecont act s.
Prev ent ionandcont rol
1.Educat ethepubl ic, andpar ticularl
yt hepar ent sofyoung
chil
dr en, oft hehazar dsofdi pht heriaandt henecessi tyfor
acti
v ei mmuni zation.
2.Immuni zat i
onofi nf antswi thdi phtheriatoxoi d.
3.Concur rentandt er minal disinfectionofar ti
cl esin
cont act
withpat ientandsoi l
edbydi schar gesofpat ient .
4.Singl edoseofpeni cil
li
n( IM)or7- 10day scour seof
Erythromy cin( PO)i srecommendedf oral l
per sons
exposedt odi pht heria.
Pertusi s( whoopi ngcough)
Definition
Anacutebact
erial
diseasei
nvol
vi
ngt
her
espi
rat
oryt
ract
.
I
nfecti
ousagent
Bordet
ell
apert
usis

Epidemi ology
Occur rence-Anendemi cdi seasecommont ochi l
dren
especi all
yy oungchi l
drenev erywhereinthewor ld.A
mar ked
decl inehasoccur redini ncidenceandmor tali
tyr ates
dur ing
thepastf ourdecades.Out br eaksoccurperiodical l
y.
Endemi c
i
ndev elopingwor ldand90%ofat tacksoccurinchi l
dren
under6y earsofage.
Reser voir-Humans
Modeoft r
ansmi ssion-Pr imar i
l
ybydi r
ectcont actwi th
dischar gesf rom respiratorymucusmembr anesof
i
nf ect ed
per sonsbyai rbornerout e,pr obablybydroplets.I ndir
ectl
y
by
handl i
ngobj ectsfreshlysol idwi thnasopharyngeal
secr etions.
Incubat ionper iod-1-3weeks
Per iodofcommuni cabilit
y-Hi ghlycommuni cabl ei nearl
y
catar rhal stagebef oret hepar oxysmalcoughst age.The
most
contagi ousdi seasewi thanat tackr at
eof75- 90%.
Gradual l
y
decreasesandbecomesnegl igibleinabout3weeks.
When
tr
eat edwi ther yt
hr omy cin,i
nf ect i
ousnessi susually5day
s
or
l
essaf teronsetoft herapy .
Suscept i
bi l
ityandr esistance-Suscept i
bil
ityto
nonimmuni zed
i
ndi vi
dual si suni versal.Oneat tackusual lyconf ers
prolongedi mmuni tybutmaynotbel i
fel
ong.
Cli
nicalmani festat i
on
Thedi seasehasi nsidiousonsetand3phases:
1.Cat ar r
hal phase
Last s1- 2weeks
Coughandr hinor r
hea
2.Par oxy smal phase
Expl osive,repet iti
veandpr ol ongedcough
Chi l
dusual lyvomi t
satt heendofpar oxy sm
Expul sionofcl eartenaci ousmucusof tenfollowedby
vomi ting
Whoop( inspiratorywhoopagai nstclosedgl ot t
is)
betweenpar oxy sms.
Chi l
dl ooksheal thybet weenpar oxysms
Par oxy sm ofcoughi nterfereswi t
hnut ri
tionandcough
Cy anosi sandsubconj unctiv ahemor rhageduet o
viol
entcough.
3.Conv alescentphase
Thecoughmaydi mi ni shsl owlyormayl astlongtime.
Af teri mpr ovementt hedi seasemayr ecur.
Diagnosi s
Dif fi
cul tt odi sti
ngui shi tfrom otherURTI
Hist or yandphy sical exami nati
onatphaset wo
(parox ysmal phase)ensur et hediagnosis.
Mar kedl ymphocy tosi s.
Treat ment
1.Er ythr omy cin-t ot reatt hei nfecti
oni nphaseonebutt o
decr easet ransmi ssi oni nphaset wo
2.Ant i
bi oticsf orsuperi nf ectionsli
kepneumoni abecause
of
bact erial inv asionduet odamaget ocili
a.
Nur singcar e
1.Pr operf eedingoft hechi l
d.
2.Encour agebr east feedi ngi mmedi atelyafteranattack
(eachpar oxy sm) .
3.Pr operv ent i
lation-cont i
nuouswel l
humi di f
iedoxygen
admi nistrat ion.
4.Reassur anceoft hemot her( caregiver),
Prev ent ionandcont rol
1.Educat et hepubl i
caboutt hedanger sofwhoopi ng
cough
andt headv antagesofi ni ti
at i
ngimmuni zati
onat6weeks
ofage.
2.Consi derprotectionofheal thwor ker sathighr i
skof
exposur ebyusi nger ythromy cinf or14day s.
Pneumococcalpneumoni a
Def i
niti
on
Anacut ebacterial
infect i
onoft hel ungt i
ssueandbr onchi.
Infecti
ousagent
Streptococcuspneumoni a( pneumococcus)
Epidemi ology
Occur rence-Endemi cpar ti
cularlyini nfancy ,
oldageand
personswi t
hunder lyingmedi cal condi ti
ons.Epi demics
can
occuri ninsti
tut
ions, bar r
acksandonboar dshipwher e
people
arelivi
ngandsl eepi ngi nclosequar t
er s.Commoni nlower
Socio-economi cgr oupsanddev elopingcount r
ies.
Reser voir
-Humans-pneumococci areusual lyfoundi nthe
URTofheal thypeopl et hroughoutt hewor ld
Modeoft r
ansmi ssion-dr opletspr ead, dir
ectoral contact
or
i
ndi r
ect l
ythroughar ti
clesf reshlysoi ledwi threspi r
atory
discharges.Persont oper sont ransmi ssioniscommon.
Incubat i
onper i
od-notwel ldetermi ned, maybeasshor t
as
1-3day s.
Per i
odofcommuni cabili
ty-Unt i
l dischar gesofmout hand
nosenol ongercont ainv i
rul
entpneumococci i
nsi gnif
icant
number .
Suscept ibili
tyandr esi stance-Suscept ibi
li
tyisi ncreased
by
Influenza, pulmonar yedemaofanycause, aspiration
followi ng
alcohol int oxication, chroni clungdisease,exposur eto
i
r ri
tant s
i
nt heai r, etc.Mal nut riti
onandl owbi r
thwei ghtar e
i
mpor tant
riskf act orsi ninfant sandy oungchildrenindev el
oping
count ri
es.I mmuni t
yf oll
owi nganat tackmayl astfory ear
s.
Cl i
ni calMani fest ation
Suddenonsetofchi l
l
, f
ev er,
pleuralpai
n, dyspnea,
tachy pnea, acoughpr oductiveofrustysput um,
Chesti ndr awi ng, shal l
owandr apidrespirati
oni n
i
nf ant s
andy oungchi ldren.
Vomi ti
ngandconv ulsionmayoccuri ninfant sand
young
chi ldren.
Di agnosi s
Basedoncl ini
cal gr ounds
ChestX- r
ay -reveal sconsol i
dati
onoft heaf fectedlung
tissuebutnoti nchi l
dr en.
Sput um gr am st ain-r evealsgram negativedi plococci
Treatment
1.Antipyreti
candantpai n
2.Antibi
ot i
cslikeAmpici
lli
norprocainepenici
l
li
nfor
adult
s
butusuallycrystal
li
nepenicil
li
nforchil
dren
3.Anticonvulsantsfori
nfants.

Nur singcar e
1.Moni torvi
tal signsespeci all
yofchildren.
2.Mai ntai
nhighbodyt emper aturetonor mal .
3.Inter mitt
entadmi nistr
ationofhumi difiedoxy genif
i
ndicat edespeci all
yf ory oungchi l
dren.
4.Ti mel yadmi nistrat i
onofor deredmedi cati
on.
Prev ent i
onandcont rol
1.Tr eat mentofcases
2.Tr eat mentofot herunder l
yingmedi cal condit
ions
3.Impr ovedstandar dofl ivi
ng( adequateandv entil
ated
housi ngandbet ternut ri
ti
on)
4.Av oi dovercrowdi ng.
Meni ngococcal Meni ngi
tis
Definition
Anacut ebact erialdi seaset hatcausesi nflammat ionof
thepi a
andar achnoidspace.
Infect i
ousagent
Nei sser i
ameni ngiti
des( themeni ngococcus)
Epidemi ology
Occur rence-Gr eatesti ncidenceoccur sdur i
ngwi nterand
spring.Epi demi csoccuri rr
egularly .Commoni nchi ldr
en
and
youngadul ts.I tisalsocommoni ncr owdedl i
ving
condi tions.
Reser voir-Humans
Modeoft ransmi ssion-Di r
ectcont actwi threspi r
atory
dropl etsf rom noseandt hroatofi nfectedper son.
Incubat i
onper i
od-2- 10day ,commonl y3- 4day s.
Per iodofcommuni cabi li
t y
-asl ongast hebact eri
ais
presenti nt hedi schar ge.
Suscept ibili
tyandr esi stance-Suscept i
bili
tyisl owand
decr easeswi thage
ClinicalMani festation
Suddenonsetoff ever,int
enseheadache, nauseaand
oftenv omi ting, neckst iff
nessandf r
equent l
y ,petechial
rashwi thpi nkmacul es.
Ker nig’ssi gnmaybeposi ti
ve( i.e.patientfeel sback
pain
whenoneoft helowerl i
mbsi sflexedatt hekneej ointand
extendedf or war dinanel evatedposi ti
on)
Br udinski ’
ssi gnmaybeposi tiv e(i.
e.whent hepat i
ent’
s
necki sflexed, thetwol owerext remi t
iesgetf lexedor
raisedup) .
Deliri
um andcomaof tenappear .
Diagnosi s
Basedoncl i
nical andepidemi ologicalgr
ounds
Whi tebloodcel l count.(neut
rophi l
s)
Cer ebrospinal fluidanalysis(Gr am stai
n,whi
tecel
l
count ,
etc.)
Treat ment
1.Admi tthepat ientandadmi ni
st erhighdoseof
crystalli
ne
penicilli
nintravenousl y
2.Ant ipyreti
c
Nur singcar e
1.Mai ntai
nfluidbal ance( i
nputandout put)
2.Mai ntai
nbodyt emper aturetonor mal
3.Ti melyadmi nistrat i
onofant i
biot i
cs
4.Moni torvi
tal signs.

Prevent
ionandcont r
ol
1.Educatethepubl i
contheneedt oreducedirectcont
act
andexposur etodropleti
nfect
ion.
2.Reduceov ercr
owdi ngi
nwor kplaces,
schools,camps,
etc.
3.Vacci
nescont aini
nggroupA, CandYst r
ains.
4.Chemot herapyofcases.
5.Chemopr ophy l
axis( e.g.Rifampi nfor2day s)
6.Repor ttot heconcer nedheal thauthor i
ti
es.
Tuber culosi
s
Def i
niti
on
Achr onicandi nfect i
ousmy cobact eri
al di
seasei mpor tant
asa
maj orcauseofi llnessanddeat hinmanypar t
soft he
wor l
d.
Infecti
ousagent .
My cobact er
ium tuber culosi s-humant uberclebaci l
l
i
(commonestcause)
My cobact er
ium bov i
s-cat tl
eandmani nfecti
on
My cobact er
ium av ium-i nfect ioninbirdsandman.
Epidemi ology
Occur rence-Wor ldwi de, howev erunderdev el
opedar eas
are
mor eaf f
ected.Af fectsal lagesandbot hsexes.Age
groups
between15- 45y earsar emai nlyaff
ected.Accor dingt othe
WHO1995r eport,9mi lli
oncasesand3mi l
li
ondeat hs
hav e
occurred.Accor dingt ot heMi ni
str
yofHeal threportin
1993
E.C,tuberculosiswasal eadi ngcauseofout pati
ent
mor bidit
y
(ranked8t hwi t
h2. 2%) ,leadi ngcauseofhospi t
ali
zation
(ranked3r dwi th7.8%)andl eadingcauseofhospi taldeat
h
(ranked1stwi t
h10. 1%) .Tuber culosi shast womaj or
clinical
forms.Pul monar y( 80%)pr imar i
lyoccur sdur i
ngchi l
dhood
andsecondar il
y15- 45y earsorl at er
.Theot heri sext ra
pul monar y,whi chaf fect sal l partsoft hebody .Most
common
sitesar el ymphnodes, pleur a, Geni t
our inaryt ract ,bone
and
j
oi nts,meni ngesandper i
toneum.
Modeoft ransmi ssi on-Thr oughaer osol i
zeddr opl ets
mai nly
from per sonswi thact iv eul cer ativelesi onofl ungexpel l
ed
dur i
ngt alki
ng, sneezi ng, singi ng, orcoughi ngdi rectly.
Unt reatedpul monar yt uber cul osi sposi tive( PTB+)cases
are
thesour ceofi nfection.Mosti mpor tanti st hel engt hof
ti
meof
cont actani ndiv i
dual shar esv olumeofai rwi t
han
i
nf ectious
case.Thati sint i
mat e, pr olongedorf requentcont acti s
requi r
ed.Tr ansmi ssi ont hroughcont ami natedf omi tes
(clothes, per sonal articles)i sr are.Ingest ionof
unpast eur i
zed
mi lktransmi tsbov inet uber cul osis.Ov ercrowdi ngand
poor
housi ngcondi ti
onsf av orthedi seaset ransmi ssion.
Incubat i
onper i
od-4- 12weeks
Per i
odofcommuni cabi li
ty-asf arast hebaci ll
iispresent
i
n
thesput um
Suscept ibilityandr esist ance-under3y ear
sol dchildren,
adol escent s, youngadul ts,thev eryoldandt he
i
mmunosuppr essed
aresuscept i
bl e.Ev ery onewhoi snon- infectedor
non- vacci nat edcanbei nfected.
HIVi sani mpor tantr iskf actorfort hedev el
opmentof
HIVassoci ated
tuber culosi sbyf acili
tating:
React i
vat ionor
Pr ogressi onofr ecenti nfecti
onor
Rei nfect ion
ClinicalMani festation
Pul monar yt uber culosi s
Per sistentcoughf or3weeksormor e
Pr oduct iv ecoughwi thorwi thoutbl ood-stainedsput um
Shor tnessofbr eat handchestpai n
Intermi ttentf ever s,nightsweat s,l
ossofwei ght,
lossof
appet i
te,fat igueandmal aise
TBl y mphadeni t
is
slowl ydev elopingandpai nl
essenl argementofl ymph
nodesf ollowedbymat ti
nganddr ainageofpus.
Tuberculosi spleurisy
Painwhi l
ebr eathingin,dulll
owerchestpai n,
sli
ght
cough, br
eat hlessnessonexer t
ion.
TBofbonesandj oints
Local i
zedpai nand/ orswell
ing,dischargingofpus,
muscle
weakness, par aly
sisandst i
ff
nessofj oint
s.
Int
estinalTB
Lossofwei ghtandappet i
te
Abdomi nal pain,diarr
heaandconst i
pation
Massi nt heabdomen
Fluidint heabdomi nalcavit
y( asci
tes)
Tuberculosmeni ngi t
is
Headache, fever,vomi ti
ng,neckst i
ff
nessandment al
confusionofi nsidiousonset .

Diagnosi s
1.Clinical manifestat
ions
2.Sput um smear sforacid-f
astbacil
li(
AFB) ,whichisthe
Goldenst andard.Howev er,onepositi
veresultdoesnot
j
ustifyst arti
ngant iTBtreatmentsinceerrorscannev erbe
excluded.
3.Aci d-f
astst ai
nf orAFBcanbedonef orextrapulmonary
tuberculosishav ingpus-ydischar
ge.
4.Radi ologicalexamination:Thi
sisunr el
iabl
ebecausei t
canbecausedbyav ar i
etyofcondi tionsorpr evi
ousTB
patient swhoar ehealedmayhav echestx- r
aygivingthe
appear anceofact i
veTB, whi chr equi rest r
eatment .
5.Hi st opat hol ogicalex aminat ion: Biopsi esfor
extrapul monar yTB( e.g.Tuber culosl ymphadeni ti
s)
6.Tuber cul int est(mant oux): Helpf ul i
nnon- BCG
vacci nat ed
childr enunder6y earsofage
7.Cul tur e: Compl exandsophi sticat edt ool,
whicht akes
sev eral weekst oyi
eldr esults.Notapr i
mar ydiagnostic
tool inourcount ry.
Treat ment
Thef ol l
owi ngdr ugsar ebei ngusedf ortreatmentofTB
St rept omy cin(s)dai l
yIMi njection
Et hambut ol(E)
Ri fampi n(R)
Thi acet azone( T)
Isoni azi d(H)
Py razi nami de(Z)
Alldr ugs, exceptst r
ept omy cin, whichi sadmi ni
stereddail
y
throughi nr out e)aretobet akenor al lyasasi ngl
edai l
y
dose
pref erabl yonanempt yst omach.
Drugr egi mens( prescr i
bedcour seoft herapy)
1)Shor tcour sechemot herapyr egimen
(DOTS)i ntensi vephase-S( RH) Zf ort womont hs
 Cont inuat i
onphase-TH( EH)fort henext6mont hs.
2)Longcour sechemot herapyr egimen.
Intensiv ephase-S( TH)orS( EH)f or2mont hs
Cont inuat i
onphase- THorEHf orthenext10mont hs
Nur singcar e
1.Educat et hepat i
enthowandwhent ot akethe
prescr i
bed
medi cat i
on.
2.Tel lthepat i
entnott ost opt hemedi cat ionunless
he/ shei s
toldt odoso.
3.Tel lthepat i
entt ocomet ot heheal t
hi nstit
uti
oni f
he/ she
dev elopsdr ugsi deef fects.
4.Adv i
cet hepat ientont hei mpor tanceoft aki
ngadequat e
andbal anceddi etandt oeatwhati sav ai
lableathome.
Pr eventionandcont rol
1.Chemot her apyofcases
2.Chemopr ophy laxisforcont acts
INH( I
soni azid)f oradul t
sandchi ldrenwhohav eclose
cont actwi tht hesour ceofi nfecti
on
3.I mmuni zationofi nfantswi thBCG
4.Educat epat i
ent swi thTBaboutt hemodeofdi sease
transmi ssionandhowt odi sposet heirsput um andcov er
theirmout hwhi l
ecoughi ng, sneezing,et c.
5.Publ icheal t
heducat i
onaboutt hemodesofdi sease
t
ransmissionandmet hodsofcontrol
Improvedst andar dofliv
ing
Adequat enut ri
ti
on
Healthhousi ng
Envir
onment alsanitat
ion
Personal hy
gi ene;etc.
Acti
vecasef indingandt r
eatment

TheEndThanky
ou