II.

EPIDEMIOLOGICAL DESCRIPTION OF DISEASES

A. DIPTHERIA
Etiologic agent MOT Corynebacterium diphtheriae (toxin)- gram positive rod inhalation of airborne respiratory droplets (intimate contact- cutaneous diptheria) from asymptomatic carriers or convalescing patients less than 1 week colder months, children under 15 years Potential complications Diagnosis Thick, patchy, greyish-green membrane over the mucous membranes of the pharynx, larynx, tonsils, soft palate, nose Fever, sore throat Rasping cough, hoarseness Skin lesions resemble impetigo- cutaneous diphtheria Bleeding (attempting to remove membrane) Airway obstruction- Tachypnea, stridor, possibly cyanosis, suprasternal retractions, suffocation Thrombocytopenia Myocarditis Neurologic involvement (motor and sensory fibers) Renal involvement Pulmonary involvement (bronchopneumonia) Super infection (opportunistic bacteria) Visualization of characteristic membrane Throat culture or culture of other suspect lesions Diphtheria antitoxin (IM or IV) Antibiotics (penicillin or erythromycin) Tracheostomy (for airway obstruction) Immunization (given during convalescence) (infection doesnt confer immunity)

Incubation period Prevalence Clinical manifestation

Treatment

Prevention

DPT vaccine

{NOTE:Holmes, H.N. et al. Handbook of infectious diseases. Pennsylvania. Springhouse Corporation, 2000. Pages 85-86, 219220.}

{NOTE:Holmes, H.N. et al. Handbook of infectious diseases. Pennsylvania. Springhouse Corporation, 2000. Pages 85-86, 219220.}{NOTE:Holmes, H.N. et al. Handbook of infectious diseases. Pennsylvania. Springhouse Corporation, 2000. Pages 85-86, 219-220.}{NOTE:Holmes, H.N. et al. Handbook of infectious diseases. Pennsylvania. Springhouse Corporation, 2000. Pages 8586, 219-220.}

B. PERTUSSIS
Etiologic agent MOT Bordetella pertussis- gram negative coccobacillus direct inhalation of contaminated droplets from a patient in the acute stage; indirectly through soiled linen and other articles contaminated by respiratory secretions 7-10 days late winter to early spring, children less than 1 year Whooping Cough- classic 6 week course with 3 stages lasting 2 weeks each o Catarrhal stage- irritating, hacking cough, anorexia, sneezing, listlessness, infected conjunctiva, and occasionally, a low-grade fever (highly communicable stage) o Paroxysmal stage (7-14 days) - spasmodic and recurrent coughing that may expel tenacious mucus. Each cough ends in a loud, crowing inspiratory whoop, and chocking on the mucus causing vomiting (highly vulnerable to fatal secondary bacterial or viral infection) o Convalescent stage- paroxysmal coughing and vomiting gradually subside Nose bleed, increased venous pressure, periorbital edema, conjunctival hemorrhage, hemorrhage of anterior chamber of the eye, detached retina (and blindness), rectal prolapsed, inguinal or umbilical hernia, seizures, atelectasis, pneumonitis, secondary infections (otitis media, pneumonia); (infants- choking spells may cause apnea, anorexia and disturbed acid base balance) CNS complications seizures and encephalopathy Clinical manifestations Nasopharyngeal swabs and sputum culture show B. pertussis Fluorescent antibody screening of nasopharyngeal smears WBC count usually increased (175,000-200,00)

Incubation period Prevalence Clinical manifestation

Potential complications

Diagnosis

Treatment

Prevention

Supportive therapy Fluid and electrolyte replacement Adequate nutrition Codeine and mild sedation to decrease coughing Oxygen therapy for apnea Antibiotics (erythromycin, ampicillin-given in catarrhal phase) Corticosteroids DTaP vaccine (2, 4, 6 months; booster every 18mo and 4-6 years; contraindicated beyond 6 years) DPT vaccine

A. TUBERCULOSIS
Etiologic agent MOT Mycobacterium tuberculosis pulmonary tuberculosis Mycobacterium family- atypical tuberculosis direct inhalation of minute particles of infected sputum from the air during close contact; indirectly by drinking unpasteurized milk (Mycobacterium bovis) initial exposure: 6 weeks dormant phase: weeks to years acute: generalized tiredness or weakness, weight loss, fever, and night sweats severe: productive/ dry coughing, chest pain, coughing up of sputum (material from the lungs) and/or blood, and shortness of breath other organ involvement: extra-pulmonary symptoms

Incubation Period Clinical Manifestation

Potential Complications Diagnosis Treatment Prevention

BCG vaccine

D. Hepatitis B
Etiologic Agent MOT Hepatitis B Virus

blood-borne (e.g. contaminated needles) virus transmitted from one person to another via blood or bodily fluids (e.g. through sexual intercourse or open wound entry) perinatal infection: placental and maternal milk transmission is from an infected mother to a newborn child 1 to 4 months (may either be acute hepatitis B if resoved within weeks to months or chronic if persists for 6 months or longer)

Incubation period Clinical manifestation s

Appetite loss Feeling tired (fatigue) Nausea and vomiting Itching all over the body Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage) Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color) Dark urine (the color of cola or tea)

Potential complications

Pale-colored stools (grayish or clay colored) Fulminant Hepatitis B Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (hepatic encephalopathy) o Sudden collapse with fatigue o Jaundice o Swelling of the abdomen
o

Diagnosis

Liver obstruction (acites, Persistent jaundice, Vomiting with blood in the vomit, Bleeding from the nose, mouth, or rectum; or blood in the stool ) early phase of infection: simple blood test detecting the presence of hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (anti-HBc IgM)
o

indicator of immunity: blood test detecting Antibody to HBsAg (anti-HBs) Treatment Prevention HBV vaccine

E.Poliomyelitis
Etiologic agent Poliovirus (enterovirus subgroup, family Picornaviridae) o transient inhabitants of the GI tract and are stable at acid pH; o three serotypes (P1, P2, and P3) with minimal heterotypic immunity; o rapidly inactivated by heat, formaldehyde, chlorine and UV light Person-to-person spread via the fecal-oral route; although the oral-oral route may account for some cases (contact with infected mucus or phlegm from the nose or mouth, or by contact with infected feces). - The poliovirus enters through the mouth and nose and primary multiplication of the virus occurs at the site of implantation in the pharynx and GI tract. It is then absorbed and spread through the blood and lymph systems. Incubation period Prevalence -Five to 35 days (average of 7-14 days) -Six to 20 days with a range of 3 to 35 days Risks to the poliovirus include the lack of immunization against polio and subsequent exposure to polio (e.g. travel to an area that has experienced a polio outbreak). Most likely to get the disease include children (under the age of five), pregnant women, and the elderly. Poliovirus infection typically peaks in the summer months in temperate climates.

MOT

Clinical manifestation s

SUBCLINICAL INFECTION (asymptomatic or lasts 72 hrs or less)

General discomfort/uneasiness (malaise) Headache Red throat Slight fever Sore throat Vomiting Back pain/backache Diarrhea Excessive tiredness/fatigue Headache Irritability Moderate fever Muscle pain/stiffness (back, arms, legs [calf muscles], abdomen) Muscle tenderness and spasm in any area of the body Neck pain and stiffness

NONPARALYTIC POLIOMYELITIS (1-2 weeks)

Skin rash or lesion with pain Vomiting PARALYTIC POLIOMYELITIS Fever (five to seven days before other symptoms)

Abnormal sensations (but{NOTE:Centers for Disease Control and

Prevention (April 2011). Poliomyelitis. In The pink book: Epidemiology and prevention of vaccine-preventable diseases. Retrieved July 4, 2011 fromhttp://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.p df Poliomyelitis Fact Sheet (2010). In World Health Organization (WHO) online. Retrieved July 4, 2011 from http://www.who.int/mediacentre/factsheets/fs114/en/index.html Poliomyelitis (2009). In PubMed Health. Retrieved July 4, 2011 fromhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002375/ } not Potential complications loss of sensation) in an area Bloated feeling in abdomen Difficulty in breathing Constipation Difficulty in urinating Drooling Headache Irritability/poor temper control Muscle contractions or muscle spasms in the calf, neck or back Muscle pain Asymmetrical muscle weakness (one-sided or worse on one side) Sensitivity to touch Difficulty in swallowing

Aspiration pneumonia (anaerobic pneumonia) Cor pulmonale (right-sided heart failure) High blood pressure Kidney stones Permanent muscle paralysis, disability, deformity (thus lack of movement) Lung problems Myocarditis (heart muscle inflammation) Paralytic ileus (loss of intestinal function) Pulmonary edema (pulomonary congestion) Shock

Prevention

Urinary tract infections Post-polio syndrome (a complication that develops in some patients, usually 30 or more years after initial paralytic poliomyelitis infection during childhood, wherein new muscle pains and new weaknesses [or paralysis] are experienced) OPV vaccine

{NOTE:Centers for Disease Control and Prevention (April 2011). Poliomyelitis. In The pink book: Epidemiology and prevention of vaccine-preventable diseases. Retrieved July 4, 2011 fromhttp://www.cdc.gov/vaccines/pubs/pinkbook/downloads/polio.pdf

Poliomyelitis Fact Sheet (2010). In World Health Organization (WHO) online. Retrieved July 4, 2011 from http://www.who.int/mediacentre/factsheets/fs114/en/index.html

Poliomyelitis (2009). In PubMed Health. Retrieved July 4, 2011 fromhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002375/}