LAST LESSON

• Leprosy


  An infectious disease and a leading cause of permanent physical disability among the communicable diseases
• Leprosy


  • It is a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes and mucosa of the upper respiratory tract
• Mycobacterium leprae


  Causative agent of leprosy
• Slit Skin Smear (SSS)

  1. Pinch the site

  2. Make an incision

  3. Apply the interstitial fluid on a slide

  4. Air dry and stain using Ziehl-Neelsen Stain

  5. Count the number of acid fast bacilli
• Early signs and symptoms of leprosy

  • Change in color- either reddish brown/white
  • Loss of sensation on the skin lesion
  • Decrease/loss of sweating and hair growth over the lesion
  • Thickened and painful nerves
  • Muscles weakness and paralysis of extremities
  • Pain and redness of the eyes
  • Nasal obstruction or bleeding

  
• Signs of advanced leprosy

  • Loss of eyebrow- madarosis
  • Inability to close eyelids-lagopthalmus
  • Paralysis and crippling of hands and feet
  • Nose disfigurement
  • Blindness
  • Chronic non-healing ulcers on the bottom of the feet
• Prevention and control of leprosy

  • Avoidance of prolonged skin to skin contact especially with lepromatous cases
  • Children should avoid close contact with active untreated leprosy case
  • BCG vaccine
  • Practice personal hygiene
  • Adequate nutrition, rest, and exercise
• Multi-Drug Therapy (MDT)


  Ambulatory chemotherapy used for the treatment of leprosy
• Drugs used in MDT for multibacillary (MB) leprosy

  • Rifampicin
  • Clofazimine
  • Dapsone (Sulfones)
• Other drugs used to treat leprosy

  • Minocycline
  • Clarithromycin
  • Some fluoroquinolones
• Bacillary dysentery (Shigellosis)


  An acute bacterial infection of the intestine characterized by diarrhea, fever, tenesmus and in severe cases bloody mucoid stools

  
• Causative agents of Shigellosis

  • Shigella sonnei
  • Shigella boydii
  • Shigella flexneri
  • Shigella dysenteriae
• Mode of transmission of Shigellosis

  Eating of contaminated foods or drinking contaminated water and by hand to mouth transfer of contaminated materials; by flies, by objects soiled with feces of a patient or carrier

  
• Prevention and control measures for Shigellosis

  • Sanitary disposal of human feces
  • Sanitary supervision of processing, preparation and serving of food particularly those eaten raw
  • Adequate provision for safe washing facilities
  • Fly control and screening to protect foods against fly contamination
  • Protection of purified water supplies
  • Control of infected individual contacts and environment
  • Isolation of patient during acute illness
• Treatment of Shigellosis


  Ciprofloxacin, ampicillin, doxycycline, and trimethoprim–sulfamethoxazole are most commonly inhibitory for Shigella isolates. Many cases are self-limited. Give ORESOL to replace lost body fluid.
• Typhoid fever (Enteric fever)

  Systemic infection with involvement of lymphoid tissue, splenomegaly, rose spots on trunks and diarrhea. Many mild typical infections are often unrecognized.

  
• Salmonella typhi


  Causative agent of typhoid fever
• Signs and symptoms of typhoid fever

  • Sustained high fever
  • Malaise
  • Abdominal discomfort
  • Headache
  • Diarrhea or constipation
  • Loss of appetite
• Prevention and control measures for typhoid fever

  • Same as preventive and control measures as in Dysentery in addition, immunization with vaccine of high antigenicity
  • Practice safe eating and drinking habits
  • Education of the general public and particularly the food handlers
  • Wash your hands with soap and water before eating
  • Keep surroundings clean to prevent breeding of flies
• Treatment of typhoid fever

  Antibiotics, such as ciprofloxacin, may be given to adults. Ceftriaxone (injectable antibiotic) may be given to pregnant women and children. Give ORESOL to replace lost body fluid.
• Cholera (El Tor)


  An acute serious illness characterized by sudden onset of acute and profuse colorless diarrhea, vomiting, severe dehydration, muscular cramps, cyanosis and in severe cases collapse.
• Vibrio cholerae serogroup O1 or O139 (El Tor)


  Causative agent of cholera
• Signs and symptoms of cholera


  • Profuse watery diarrhea
  • Vomiting
  • Rapid dehydration (e.g. sunken eyeballs, wrinkled dry skin)
  • Most people infected with cholera are asymptomatic
• Prevention and control measures for cholera

  • Bring patient to hospital for proper isolation and prompt and competent medical care
  • A WHO pre-qualified oral cholera vaccine is available for travelers and people in endemic areas. It is given in two doses and offers protection for 3 years.
  • Other preventive measures are the same as those of Typhoid and Dysentery
• Treatment of cholera


  • Rehydration therapy
  • Antibiotic treatment is indicated for severe cases of cholera (Doxycycline / Azithromycin)
  • Zinc treatment has also been shown to help improve cholera symptoms in children.
• Hepatitis A


  A form of hepatitis occurring either sporadically or in epidemics and caused by virus introduced by focally contaminated water or food. Young people especially school children are most frequently affected.
• Hepatitis A virus (HAV)


  Causative agent of hepatitis A
• Signs and symptoms of hepatitis A


  • Influenza-like symptoms and headache
  • Malaise and fatigue
  • Anorexia and abdominal discomfort
  • Nausea, diarrhea, and vomiting
  • Fever
  • Dark urine
  • Lymphadenopathy
  • Jaundice
  • Bilirubinemia with clay colored stool

  
• Prevention and control measures for hepatitis A

  • Ensure safe water or drinking
  • Sanitary method in preparing, handling and serving food
  • Proper disposal of urine and feces
  • Washing hands very well before eating and after using the toilet
  • Separate and proper cleaning of articles used by patient
  • Hepatitis A Vaccination
• Treatment of hepatitis A

  • Postexposure prophylaxis
  • Complete bed rest
  • Adequate nutrition, and fluids
• Soil transmitted helminthiasis (STH)

  The third most prevalent infection worldwide second only to the diarrheal disease and tuberculosis. The prevalence of STH is highest among the 2 to 5 years old but they suffer the greatest impact to the disease when they are infected.

  
• Causative agents of STH in the Philippines

  • Ascaris lumbricoides (Giant intestinal roundworm)
  • Trichuris trichiura (Whipworm)
  • Hookworm: Ancyclostoma duodenale (Old world hookworm) and Necator americanus (New world hookworm)

  
• Mode of transmission of STH

  Fecal-oral route; Ingestion of eggs from fecally contaminated soil or food

  
• Signs and symptoms of STH

  • Anemia
  • Malnutrition
  • Stunted growth in height and body size
  • Decreased physical activities
  • Impaired mental and school performance
• Prevention and control measures for STH

  • Health education on good personal hygiene, keeping fingernails short and clean, use of footwear, use of sanitary facilities like toilets, and sanitary disposal of feces
  • Early diagnosis and treatment through laboratory examination of stool (fecalysis) and ensuring proper dosage of medication and completion of treatment
• Drugs used to treat STH


  Piperazine citrate, pyrantel pamoate, mebendazole, albendazole, and levimazole
• Schistosomiasis (Bilhariasis or snail fever)


  One of the important tropical diseases in the Philippines. It affects mostly farmers and their families in the rural areas, resulting in manpower losses and lessened agricultural productivity. There is a high prevalence of Schistosomiasis in Region 5 (Bicol), Region 8 (Samar and Leyte) and Region 11 (Davao).

  
• Causative agents of Schistosomiasis

  • Shistosoma japonicum – Oriental blood fluke
  • Schistosoma mansoni – Manson's blood fluke
  • Schistosoma haematobium – Vesical blood fluke

  
• Intermediate host of Schistosomiasis

  Oncomelania hupensis quadrasi

  
• Mode of transmission of Schistosomiasis

  Infection occurs when the skin comes in contact with contaminated fresh water in which certain types of snails that carry Schistosomes are living. It is a free-swimming larval form (cercaria) of the parasites that penetrates the skin. Fresh water becomes contaminated when infected people urinate or defecate in water.