PART 2

• 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
  • Also known as Hansen's disease
  • Symptoms do not appear immediately, Mycobacterium leprae multiplies slowly and the incubation is an average of 5 years
  • Kids 12 years old and below are highly susceptible

  
• Causative agents of leprosy

  • Mycobacterium leprae or Hansen's Bacilli
  • Hansen's Bacilli is an Acid Fast Bacilli
• Mode of transmissionof leprosy

  • Airborne - inhalation of droplet/spray from coughing and sneezing of untreated cases
  • Prolonged skin to skin contact
• 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-lagophthalmus
  • 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 case
  • Children should avoid close contact with active untreated leprosy case
  • BCG vaccine (Bacillus Calmette Guerin)
  • Practice personal hygiene
  • Adequate nutrition, rest, and exercise
• Treatment of leprosy

  • Ambulatory chemotherapy through use of MDT (Multi-Drug Therapy)
  • Combination: Rifampicin, clofazimine, Dapsone (Sulfones) for Multibacillary (MB) leprosy patients
  • Other drugs: minocycline, clarithromycin, and some fluoroquinolones
• Slit Skin Smear (SSS)


  1. Pinch the site

  2. Make an incision

  3. Apply the interstitial fluid on slide

  4. Air dry and stain using Ziehl-Neelsen Stain

  5. Count the number or check the presence acid fast bacilli
• The main objective of Slit Skin Smear is to prevent misclassification and wrong treatment
• 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 bacillary dysentery

  Shigella, there are four main groups: Shigella sonnei, Shigella boydii, Shigella flexneri, Shigella dysenteriae
• Mode of transmission of bacillary dysentery

  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

  
• 4Fs of bacillary dysentery transmission

  • Food, fingers, feces, and flies

  
• Prevention and control of bacillary dysentery

  • 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 bacillary dysentery

  • 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

  
• Causative agent of typhoid fever

  Salmonella typhi
• Mode of transmission of typhoid fever

  • Direct or indirect contact with patient or carrier
  • Principal vehicles are food and water
  • Flies are vectors

  
• Source of infection for typhoid fever

  Contaminated feces or urine from an infected person

  
• Signs and symptoms of typhoid fever

  • Sustained high fever
  • Malaise
  • Abdominal discomfort
  • Headache
  • Diarrhea or constipation
  • Loss of appetite

  
• Preventive 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
• Causative agent of cholera

  Vibrio cholerae serogroup O1 or O139 (El Tor)
• Mode of transmission of cholera

  Food and water contaminated with vomit and stool of patients and carrier
• 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 of 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)
  • Doxycycline - adults
  • Azithromycin - children and pregnant
  • 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 viruses introduced by locally contaminated water or food
  • Young people especially school children are most frequently affected
• Causative agent of hepatitis A

  • Hepatitis A virus (HAV)
  • Picornaviridae - the target of this virus is liver
• Mode of transmission of hepatitis A

  Fecal-oral route or consumption of contaminated food or water

  
• 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
• Prevention and control of 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 patients
  • Hepatitis A Vaccination
• Treatment of hepatitis A

  • Postexposure prophylaxis
  • Complete bed rest
  • Adequate nutrition and fluids

  
• Soil transmitted helminthiasis (STH)

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

  
• Causative agents of STH

  • 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 of STH

  • Health education: Good personal hygiene, Keeping fingernails short and clean, Use footwear, Use sanitary facilities like toilets, Sanitary disposal of feces
  • Early diagnosis and treatment: Laboratory examination of stool (fecalysis), Ensure proper dosage of medication and completion of treatment