EPI DISEASES

• Tuberculosis has other names: Koch's Disease, Consumption, Phthisis, Weak lungs
• Causative agent of Tuberculosis

  Mycobacterium tuberculosis, TB bacillus, Koch's bacillus, Mycobacterium bovis (rod-shaped)
• Mode of transmission of Tuberculosis

  Airborne-droplet, Direct invasion through mucous membranes and breaks in the skin (very rare), Incubation period: 4-6 weeks
• Pathognomonic signs of Tuberculosis

  • Usually asymptomatic
  • Low-grade afternoon fever
  • Night sweating
  • Loss of appetite
  • Weight loss
  • Easy fatigability - due to increased oxygen demand
  • Temporary amenorrhea
  • Productive dry cough
  • Hemoptysis
• Tuberculosis Diagnosis

  1. Sputum examination or the Acid-fast bacilli (AFB)/ sputum microscopy

  2. Chest X-ray

  3. Tuberculin Test (Mantoux Test, Tine test)

  
  

  Mantoux Test

  -used for single screening, result interpreted after 72 hours

  Tine Test

  -Used for mass screening, result interpreted after 48 hours
• Tuberculin Test Interpretation

  0-4 mm induration - not significant<|>5 mm or more - significant in individuals at risk, positive for HIV-positive or HIV risk factors, close contacts with active case, chest x-ray consistent with TB<|>10 mm or greater - significant in individuals with normal or mildly impaired immunity
• Tuberculosis Prevention

  • Respiratory precautions
  • Cover mouth and nose when sneezing
  • Give BCG vaccine
  • Improve social conditions
• Tuberculosis Treatment Side Effects

  • Ethambutol: Optic neuritis, Blurring of vision, Inability to recognize green from blue
  • Streptomycin: Damage to 8th cranial nerve, Tinnitus, Nephrotoxic
• Tuberculosis Treatment Regimens

  • Category 1: 6 months SCC
  • Category 2: 8 months SCC
  • Category 3: 6 months SCC
  • Category 4: Chronic (Referral needed)
• Tuberculosis Treatment Side Effects

  • Rifampicin: Body fluid discoloration, Hepatotoxic, Permanent discoloration of contact lenses
  • Isoniazid: Peripheral neuropathy (Give Vit B6/Pyridoxine)
  • Pyrazinamide: Hyperuricemia/gouty arthritis (increase fluid intake)
• National TB Control Program

  • Vision: A country where TB is no longer a public health problem
  • Mission: Ensure TB DOTS Services are available, accessible, and affordable
  • Goal: Reduce prevalence and mortality from TB by half by 2015
  • Targets: Cure at least 85% of sputum smear (+) patients, Detect at least 70% new sputum smear (+) TB cases
  • Objectives: Improve access and quality of services, Enhance health-seeking behavior, Increase and sustain support, Strengthen management
• Key Policies of National TB Control Program

  • Case finding: DSSM primary diagnostic tool, No TB Dx based on CXR alone, All TB symptomatic undergo DSSM, Only trained staff perform DSSM, Passive case finding
  • Treatment: Domiciliary treatment preferred, DSSM basis for treatment, Hospitalization recommended in certain cases, All patients supervised, Provision of quality-assured drugs
  • DOTS Strategy: Recording & reporting, Uninterrupted drug supply, Standardized SCC, Quality-assured microscopy, Political commitment
• Management of Children with Tuberculosis

  • Prevention: BCG immunization
  • Casefinding: Reported in 2 instances, Tuberculin testing for symptomatic children, Criteria for TB symptomatic, Conditions confirming TB diagnosis
  • Treatment: Same as adults, Hospitalization for severe cases
• Ring


  Failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection<|>Failure to regain previous state of health 2 weeks after a viral infection or exanthem (e.g. measles)
• Conditions confirming TB diagnosis

  • (+) history of exposure to an adult/adolescent TB case
  • (+) signs and symptoms suggestive of TB
  • (+) tuberculin test
  • Abnormal CXR suggestive of TB
  • Lab findings suggestive or indicative of TB
• For children with exposure to TB

  1. Child with exposure to a TB registered adult patient shall undergo physical exam and tuberculin testing

  2. Child with productive cough shall be referred for sputum exam, for (+) sputum smear child, start treatment immediately

  3. TB asymptomatic but (+) tuberculin test and TB symptomatic but (-) tuberculin test shall be referred for CXR examination
• For TB symptomatic children

  1. TB symptomatic child with either known or unknown exposure to a TB case shall be referred for tuberculin testing

  2. (+) contact but (-) tuberculin test and unknown contact but (+) tuberculin test shall be referred for CXR examination

  3. (-) CXR, repeat tuberculin test after 3months

  4. INH chemoprophylaxis for three months shall be given to children lessthan5y.o.with(-)CXR; after which tuberculin test shall be repeated
• Treatment (Child with TB)

  1. Pulmonary TB: Intensive - 3 anti-TB drugs (R.I.P.) for 2 months, Continuation - 2 anti-TB drugs (R&I) for 4 months

  2. Extra-Pulmonary TB: Intensive - 4 anti-TB drugs (RIP&E/S) for 2 months, Continuation - 2 anti-TB drugs (R&I) for 10 months
• Period of communicability of tuberculosis

  As long as bacillus is contained in the sputum<|>Primary complex in children is NOT contagious<|>Good compliance to regimen renders person not contagious 2-4 weeks after initiation of treatment
• Diphtheria types

  Nasal<|>Pharyngeal - most common<|>Laryngeal - most fatal due to proximity to epiglottis
• Diphtheria transmission


  Increased in hospitals, households, schools, and other crowded areas<|>Droplet especially secretions from mucous membranes of the nose and nasopharynx and from skin and other lesions<|>Milk has served as a vehicle
• Diphtheria incubation period

  1. 5 days
• Diphtheria symptoms


  Pseudomembrane-mycelia of the oral mucosa causing formation of white membrane on the oropharynx<|>Bull neck<|>Dysphagia<|>Dyspnea
• Diphtheria diagnostic tests


  Nose/throat swab<|>Moloney's test - a test for hypersensitivity to diphtheria toxin<|>Schick's test - determines susceptibility to bacteria
• Diphtheria drug of choice

  Erythromycin 20,000 - 100,000 units IM once only
• Diphtheria complication


  Myocarditis (Encourage bed rest)
• Diphtheria prevention


  DPT immunization<|>Pasteurization of milk<|>Education of parents<|>Infants born to immune mothers maybe protected up to 6-9 months. Recovery from clinical attack is always followed by a lasting immunity to the disease.
• Pertussis


  Whooping cough<|>Tusperina<|>No day cough
• Pertussis causative agent

  Bordetella pertussis<|>Hemophilus pertussis<|>Bordet-gengou bacillus<|>Pertussis bacillus
• Pertussis incidence and mortality

  Highest under 7 years of age<|>Highest among infants (<6 months)
• Pertussis immunity


  One attack confers definite and prolonged immunity. Second attack occasionally occurs
• Pertussis transmission


  Droplet especially from laryngeal and bronchial secretions
• Pertussis incubation period

  1. 10 days but not exceeding 21 days
• Pertussis symptoms


  Catarrhal period: 7 days paroxysmal cough followed by continuous nonstop accompanied by vomiting
• Pertussis complication

  Abdominal hernia
• Pertussis diagnosis

  Bordet-gengou agar test
• Pertussis management

  1. DOC: Erythromycin or Penicillin 20,000 - 100,000 units

  2. Complete bed rest

  3. Avoid pollutants

  4. Abdominal binder to prevent abdominal hernia
• Pertussis prevention

  DPT immunization<|>Booster: 2 years and 4-5 years<|>Patient should be segregated until after 3 weeks from the appearance of paroxysmal cough
• Poliomyelitis


  Infantile paralysis<|>Legio debilitans
• Poliomyelitis causative agent


  Polio virus<|>Enterovirus