Communicable Diseases

Lock jaw

An acute exotoxin mediated infection

characterized by neuromuscular manifestations. CA: clostridium tetani (soil, dust) MOT: through traumatic breaks in the skin
Contamination of unhealed umbilical stump.

IP: 7-14 days

Anaerobic, spore-forming, gram positive (+) rod With round terminal spores giving it a drumstick appearance

Wound Clostridium tetani will germinate in he wound

Release of exotoxin
Blocks the release of inhibitory neurotransmitters Unopposed excitatory neurons Extreme muscle spasm

Onset: insidious with muscular spasms and cramp-like pain around the site of inoculation Irritability and restlessness with progressively increasing stiffness of the voluntary muscles

Jaw: Neck & back: Face: Trunk: Extremities:

trismus or lockjaw opisthotonus risus sardonicus rigid, board-like abdomen stiff and extended

Localized Signs of onset are spasms and increased muscle tone around the wound

Systemic or Generalized Marked muscular tonicity Hyperactive deep tendon reflexes Painful involuntary muscle contraction lockjaw or trismus risus sardonicus Boardlike abdominal rigidity Opisthotonus Intermittent tonic convulsions

Neonatal tetanus is always generalized. Difficulty in sucking between 3-10 days after birth. inability to suck (jaw becomes too stiff), with excessive crying irritability and nuchial rigidity

May end with flaccidity, anorexia, exhaustion,

and finally death

Primarily a clinical diagnosis (history and physical exam) Organism is rarely isolated.

Serologic tests not useful.

Hyperimmune human globulin

to neutralize toxin

Antibiotics - Penicillin-G

Diazepam

DPT vaccine Hyperimmune globulin plus toxoid. Debride wound.

Prophylactic antibiotics
penicillin; cephalosphorins

Plasmodium species Vector-borne infectious disease caused by protozoan parasites that invade the RBC.

Female Anopheles mosquito

Vector and definitive host

Plasmodium has 4 important species that affect

humans:

Plasmodium Vivax Plasmodium Falciparum

most severe and life threatening

Plasmodium Oval Plasmodium Malariae

MOT: Bite of female Anopheles mosquito.

mature sporozoites are injected into the victim.

Blood transfusion

Contaminated needles and syringes.

EPIDEMIOLOGY: Occurs primarily in the tropical areas of

Asia, Africa, and Latin America

INCUBATION PERIOD: P. Falciparum - 12 days

P. Vivax and Ovale - 14 days

P. Malariae - 30 days Infection from blood transfusion depends on the number

of parasites, usually takes 2 months or shorter.

Chills, sweating, headache, myalgia

Has 3 stages:
Cold stage - ranging from chills to extreme shaking; lasts from 2-3 hrs. Hot stage - high fever up to >41C; lasts from 3-4 hrs. Wet stage - characterized by profuse sweating; lasts for about 2-4 hrs.

Signs and symptoms occurs when RBCs rupture Complications:

cerebral malaria
Black water fever severe destruction of RBCs dark-colored urine; high fever, jaundice, liver spleen enlargement, acute renal failure; poor prognosis

Thick and thin blood smears are the most reliable test for malaria Thick smear
detect the presence of malarial parasites
determine parasite density

Thin smear
Identify the species of plasmodium.

Chemoprophylaxis

Chloroquine - pre-exposure prophylaxis

Primaquine to prevent relapses.
areas with a high risk of chloroquine resistance,

Chloroquine resistant cases. Protection from bites. Control mosquitoes

insecticides
draining water from breeding areas.

Hansens Disease

A chronic disease of the skin and peripheral

nerves. Onset of the disease is gradual. Incubation period averages several years. Humans are the natural hosts. Cannot be cultured in vitro.

Characteristics: Hypopigmented or reddish skin lesions Definite loss of sensation

Damage to the peripheral nerves

Positive skin smear

Optimal Grows

growth

at

less in the

than skin

body and

temperature (30C)

preferentially

superficial nerves.

Has 2 distinct forms:

Tuberculoid leprosy Lepromatous leprosy

Features

Tuberculoid leprosy

Lepromatous Leprosy
Many lesions with marked tissue destruction Many

Type of Lesion

One or few lesions with little tissue destruction

Number of acid-fast Few bacilli (AFB)

Likelihood of transmitting leprosy

Cell-mediated response to M.Leprae Lepromin skin test

Low

High

Present

Reduced or absent

Positive

Negative

CA: Mycobacterium Leprae HABITAT: Human skin and nerves. MOT: Prolonged contact; direct contact
Droplet infection

Lepromatous form is more contagious than the Tuberculoid form.

Tuberculoid leprosy
hypopigmented macular skin lesions thickened superficial nerves significant anesthesia of the skin lesions occur.

Lepromatous leprosy
multiple nodular skin lesions occur Leonine facies

Multi-drug therapy: *Multibacillary leprosy = clients with (+) smear at any site combination of Rifampicin, Clofazimine, Dapsone *Paucibacillary leporsy = clients w/ (-) smears at all sites combination of Rifampicin & Dapsone

Multi-drug therapy: *Rifampicin urine may be slightly reddish in color for a few hours -- most important drug for leprosy

Completion of treatment & cure: *Paucibacillary leprosy six doses of MDT w/n 9 months considered as cured *Multibacillary leprosy 24 doses of MDT w/n 36 months considered cured

Isolation of all lepromatous patients

Chemoprophylaxis with Dapsone for exposed

children and close family contacts. Good personal hygiene. Adequate nutrition. Health education. No vaccine is available.

Acute systemic zoonotic infection.

Characterized by extensive vasculitis, influenzalike illness, jaundice, and renal dysfunction. CA: Leptospira interogans Source of infection: Water or soil contaminated w/ infected urine or tissues from infected animals.

IP: 7 -12 days

Range of 2-20 days

MOT: Direct contact w/ urine or tissue of

infected animals.
Occasionally through ingestion of contaminated food and droplet inhalation.

First Phase
4- 7 days: non specific symptoms, Conjunctivitis Diarrhea and abdominal pain Jaundice and hemorrhagic rash.

Second Phase
Kidney or liver failure meningitis for 3 weeks or more.

Isolation of Leptospira in body fluid

Blood - 1st week CSF - 4th to 10th days during acute illness Urine - 10th day

Amoxicillin and Ampicillin

Adult
Amoxicillin 500 mg. QID, PO

Ampicillin 500-750 MG.QID,IV

Pedia
Amoxicillin 30-50 mg/Kg./Day TID, PO Ampicillin 100 mg./Kg./Day QID, IV

Proper disposal of infected urine Use Gloves Avoid wading in flood waters

Control of rodents
Chemoprophylaxis for high risk people