TOPIC 9.2

• 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

  
• 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
• 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
• Prevention and control of 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

  
• Drugs used to treat Shigellosis

  • Ciprofloxacin
  • Ampicillin
  • Doxycycline
  • Trimethoprim–sulfamethoxazole
• Typhoid fever (Enteric fever)


  Systemic infection with involvement of lymphoid tissue, splenomegaly, rose spots on trunks and diarrhea
• 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 of typhoid fever


  • 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
  • Immunization with vaccine of high antigenicity
• Drugs used to treat typhoid fever

  • Ciprofloxacin
  • Ceftriaxone (for pregnant women and children)

  
• 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 of cholera


  • Bring patient to hospital for proper isolation and prompt and competent medical care
  • Use of WHO pre-qualified oral cholera vaccine for travelers and people in endemic areas
  • Same preventive measures as those of typhoid and dysentery

  
• Drugs used to treat 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

  
• Hepatitis A virus (HAV)


  Causative agent of hepatitis A

  
• 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 patient
  • Hepatitis A Vaccination
• Treatment for 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

  
• 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)

  
• Signs and symptoms of STH

  • Anemia
  • Malnutrition
  • Stunted growth in height and body size
  • Decreased physical activities
  • Impaired mental and school performance
• Drugs used to treat STH

  • Piperazine citrate
  • Pyrantel pamoate
  • Mebendazole
  • Albendazole
  • Levimazole
• Causative agents of schistosomiasis

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

  
• Oncomelania hupensis quadrasi

  Intermediate host for schistosomiasis

  
• 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.

  
• Signs and symptoms of schistosomiasis

  • Diarrhea (bloody stool or urine)
  • Enlargement of abdomen
  • Splenomegaly
  • Weakness
  • Anemia
  • Inflamed liver
• Prevention and control of schistosomiasis

  • Educate the public in endemic areas regarding the mode of transmission and methods of protection
  • Proper disposal of feces and urine
  • Improve irrigation and agricultural practices: reduce snail habitats by removing vegetation
  • Treat snail breeding sites with molluscicides
  • Prevent exposure to contaminated water
  • Provide water for drinking, bathing and washing clothes from sources free of cercaria or treatment to kill them
  • Advise travelers visiting endemic areas of the risk and inform them
• People urinate or defecate in water
• Signs and Symptoms of Schistosomiasis

  • Diarrhea (bloody stool or urine)
  • Enlargement of abdomen
  • Splenomegaly
  • Weakness
  • Anemia
  • Inflamed liver