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Lasanthi Aryasinghe -1-

Vaccination &
Disease Agent Transmission Signs & Symptoms Complications
Treatment

RESPIRATORY INFECTIONS

- Case 1. Pre-eruptive Stage


- Droplet Infection (nuclei) 2. Eruptive Stage:
- Oropharangeal - Symetrical, Centripetal rash - Varicella Hemorrhagical
secretions - Rapid evolution of rash - Encephalitis - V-Z Ig
Chicken Pox -Varicella Zoster Virus
- Lesions of skin & - “Dew drops” - vesicles filled - Acute cerebellar Ataxia - Live Vaccine
(Varicella) (Human Alpha Herpes virus 3)
mucosa w/ clear fluid - Reye‟s Syndrome (OKA strain)
- Pleomorphism - Congenital varicella
POC: 2 days before rash
4-5 days after IP 14-16 days

- Case
1. Prodromal Stage:
- No carriers
- Koplik’s spots – small bluish, - Measles ass. diarrhoea
- Droplet infection (nuclei)
white spots on buccal mucosa, - Pneumonia
- Nose, throat & resp tract st nd
opp 1 & 2 upper molars - Otitis Media
secretions during
(2days before rash) - Febrile convulsions - Reconstituted
prodromal stage and
-3Cs coryza cough conjuctivitis - Encephalitis Measles Vaccine
Measles - RNA Paramyovirus early stages of rash
2. Eruptive Stage - Sub-acute sclerosing @ 9mts
(Rubeola) - Only 1 serotype (eruption time)
- Dusky red, maculo-papular panencephalitis (SSPE) - MMR
rash begins behind ears--face-- - Keratomalacia & - NHIg
POC: 4 days before rash
neck--lower limbs blindness from corneal
5 days after
3. Post-Measles Stage scarring
Isolate for 7 days after
IP 10-14 days
onset of rash

- Case
- 50–65% are asymtomatic
- Subclinical case - Arthralgia
- Short duration (3 days)
- Droplets from nose, - Encephalitis
1. Prodromal Stage
throat - Droplet nuclei - Thrombocytopenic - RA 27/3 Live
2. Lymphadenopathy
Rubella - RNA virus (aerosols) purpura vaccine
- Postauricular & postcerival
(German - Togavirus family - Max infectivity during - Congenital rubella – - MMR @ 12-18
3. Rash
Mesasles) - Only 1 Antigenic type eruption virus inhibits cell division; months giving life
- Minute, discreet, pinkish, st
1 trimester most long immunity
macular rash – spreds (and
POC: 7 days before rash dangerous= PDA +
clears) rapidly to trunk and ext.
7 days after rash cataracts + deafness
faster than measles
fades
Lasanthi Aryasinghe -2-
IP 2-3 weeks

- Meningoencephalitis
- Case - Ear ache
- Orchitis
- Subclinical case - Parotid swelling, sub-
- Epididymitis
- Droplet infection & mandibular and sublingual
- Oopheritits - Mumps Live
Direct contact glands may also be involved
- RNA virus - Pancreatitis vaccine
- Max infectivity at onset
- Myxovirus parotiditis - Nephritis - MMR
Mumps of parotitis
- Genus; Rubulavirus - Myocarditis, thyroiditis, - Rubella-Mumps
Mastitis, Arthritis, optic vaccine
POC: 4-6 days before
neuritis, keratitis &
6 days after illness IP 2-3 weeks
thrombocytopenic
purpura

- Lasts for 6-8weeks


1. Catarrhal Stage (10days)
- DPT
Cough, coryza
- Pertussis – Killed
- Case 2. Paroxysmal Stage (2-4 wk)
whole cell vaccine:
- Droplet infection & Explosive cough, child is - Bronchitis
contraindicated in
- Gram negative bacilli: Direct contact chocked, anxious, unable to - Broncopnemonia
H/O epilepsy,
- Bordetella pertussis: - Nasopharangeal & breathe. Bout of cough ends w/ - Bronchiectasis
convulsions,
- Clinical disease– encapsulatd, bronchial secretions long drawn out inspiratory - Subconjunctival hmrhgs
Pertussis febrile illness
Phase 1 strains - Freshly contaminated crowing sound- whoop, prod by - Epistaxis
(Whooping - No maternal Ab
- 3 major agglutinogens (1,2,3) formites air gushing thru half opened - Haemoptysis
Cough) protection
- Max infectivity catarrhal glottis. Bout ends in the child - Punctate cerebral
- B parapertussis (5% of cases) stage vomiting thick tenacious hmrhgs
- Cases:
sputum. - Hernias
- Erythromycin or
POC: catarrhal and 3. Convalescent Stage - Rectal prolapse
ampicillin
paroxysmal stage (1-2 wks)
- Nebulization w/
Interval b/w bouts & severity 
salbutamol
IP 7-14 days

- Corynebacterium diphtheriea: - Case - Greyish/yellowish membrane - Myocarditis - Cases:


- Toxigenic strains- powerful - Subclinical case on pharngotonsilar area “False - Loss of visual accomod. Dipth Antitoxin +
exotoxin- responsible for S/S - <<Carriers (temp or Membrane” – cannot be wiped - Fluid regurgitation Penicillin/
Diphtheria - Biotypes: gravis,mitis and chornic, nasal or throat): away - Polyneuritis. Erythromycin
intermedius Ratio- 95carriers : 1case - Marked edema of - Fatality due to: - Carriers:
- Airborne - Dust submandibular area + Toxeamia Erythromycin
1. Respiratory Diptheria: - Fomites lymphadenopathy-“Bull Neck” Laryngeal stenosis
- Pharyngotonsillar - Direct inf – skin lesions  airway obstruction and Bronchospasm - DPT:
Lasanthi Aryasinghe -3-
- Nasal (mildest form) - Droplet – N/P secretions stridor Respiratory failure contraindicated in
- Laryngotracheal H/O epilepsy,
- Skin lesions/ulcer surrounded - Provocative reactions = convulsions,
2. Nonrespiratory Mucosal : POC: 2-4 weeks by erythema & covered with a poliomyelitis febrile illness
- Conjuntival & Genitals membrane - Schick Test:
- Presence of
3. Cutaneous Diphtheria antitoxin (immunity
IP 2-6 days status)
- Hypersensitivity to
dipth. toxin or
protiens

In children/adults: vomiting, - Tertravalent


- Case –negligible source
fever, headache, stiff neck, light Polysaccharide
- Subclinical Cases:
- Nisseria Meningitides: aversion, drowsy, joint pain, vaccine (A,B,C, W135) :
immunity mostly
- Sero-types A,B,C,W135 cause fitting, rash esp. on limbs and Revaccinate 3-5yrs
acquired by Subclinical
epidemics (A & C mainly) trunk - Rash
infection
- Gram negative diplococci *place glass over rash, if does - Shock - Cases:
- Carriers 80-90% in
not disappear it is menig. rash - Intravasculr coagulation - Casefatality 95%
epidemics most imp.
- In Neonates: E. Coli, Proteus, In babies: fever w/ cold - Renal failure - Penicillin or
source of infection
Group B Streptococci hands/feet, fretful, refusing - Peripheral gangrene Chloramphenicol
Menigitis - Droplet Infection
feeds/vomiting, neck retraction - Arthritis - Dexamethazone
- N/P secretions
- In Children: H. Influenza, N w/ arching back, lethargic, - Pericarditis to  edema +
Meningitides, S Pneumoniae pale blotchy complexion - Waterhouse neuro damage
Difficult to control b/c of
Freidichsen syndrome: - IV mannitol for
subclinal cases and
- In Adults: N Meningitides, S On clinical exam, hypertonia w/ adrenal insufficiency diuresis  intra
carries
Pneumoniae, Lysteria, TB, H neck rigid, arthritis, Brudinski’s cranial tension
Influenza, Cryptococcus sign & Kernig’s sign = +ve - Carriers:
POC: Noninfective within
- Rifampicin
24hrs of treatment
IP 3-4 days or 2-10 days - Ciprofloxacin

- Gram positive, Acid fast bacilli - Cases of Multibacillary - Face: Mask face, leonine Intensive and extensive Multidrug Therapy:
- Mycobacterium lepre leprosy- main source faceis, lagophthalmous (eye rehab centers: 1. Multibacillary
- Subclinical Cases doesn‟t close completely- leads - Prevent physical leprosy; 12months:
Types: to corneal damage), loss of deformities by early - Rifampicin
Leprosy
- Indeterminate Animal Reservoirs: eyebrows, eyelashes, corneal diagnosis and treatment - Dapsone
(Hansen’s
- Tuberculoid (Lepromin +ve) - Armadillos ulcers & opacities, perforated “Preventive rehab” - Clofazamine
Disease)
- Borderline - Mangaba monkeys nasal septum, depressed nose,
- Lepromatous (Lepromin –ve) - Chimpanzees nodules on the ear lobules and - Rehabilitation measures 2. Paucibacillary
elongated ears such as medical, surgical, leprosy; 6months:
Paucibacillary: 1-5 lesions - Direct Contact educational & vocational - Rifampicin
- Droplet Infection - Hands: Claw hand, wrist drop, - Dapsone
Lasanthi Aryasinghe -4-
Multibacillary: >5 lesions - Formites ulcers, absorbtion of digits,
(Borderline & Lepromatous) contractures, aollowing of
POC: Noninfective within interosseous spaces and Lepra Reactions:
1 day of treatment swollen hand Immunologically
mediated episodes
- Feet: Planter ulcers, foot drop, of acute and sub
inversion of foot, clawing of acute inflammation,
toes. Absorbtion of toes, if not promptly
callosities and swollen foot treated may lead to
serious deformities
- Others: Gynaecomastia and b/c peripheral
perforation of palate nerve trunks are
involved:
IP 9 months- 10 years - Type I reaction
- Type II reaction
(erythema nodosum
leprosum)
- Corticosteroids
- Clofazamine

Rifampicin - Hepatotoxity,
nephrotoxicity, gastritis,
thrombocytopenia
- Human Case
- Rapid & Slow multipliers
- Bovine – Infected milk - BCG @ birth
- Droplet Infection (nuclei)
INH - Peripheral
- 5000 bacilli/1mL: - Fever with night sweats DOTS strategy:
neuropathy, GI irritation,
positive smear - Weight loss -Intensive 2months:
hepatotoxicity
- 10,000 bacilli/1mL: 95% - Anorexia Rifampicin (BC)
- Rapid multipliers
probability positive - Malaise INH (BC)
- Sputum smear +ve pts - Chronic cough + expectoration Pyrazinamide (BC)
Streptomycin - Vestibular
are major source of - Chest pain Ethambutol (BS)
damage and nystagmus
Tuberculosis - Mycobacterium Tuberculosis infection in community - Blood streaked sputum to
- Rapid multipliers
- Sputum smear -ve pts frank haemoptysis -Continuation 4mts:
responsible for 15-20% of INH
Pyrazinamide -
transmission (-ve in extra- IP weeks, months or years Rifampicin
Hepatotoxicity,
pulmonary TB) From exposure to +ve
hyperuricemia
Tuberculin Test takes 3-6 - Prophylaxis:
- Slow multipliers
POC: Pt infective as long weeks INH for 1yr or INH
(persisters)
as he remains untreated; + Ethambutol for
infectivity 90% within 9months
Ethambutol - Retrobulbar
48hrs of treatment
neuritis

Thioacetazone (BS) -
Lasanthi Aryasinghe -5-
Urticaria, GI irritation,
blurring of vision

INTESTINAL INFECTIONS

Provocative poliomyelitis:
Risk factors precipitate an
IPV (Salk):
-Malaise, anorexia, abd pain, attack of polio in people
• Killed virus
nausea, vomitting, headache, who are infected by the
- Case • SC or IM
constipation, Meningeal virus:
- <<Subclinical cases • No local immunity
irritation- stiff neck and back  Trauma
- Feco-oral • Does not prevent
- Tripod Sign - sits by  Operative procedures
- Droplet Infection reinfection
supporting hands at back,  Rigorous physical
- Feaces, orophayrengeal • Not useful in
- RNA virus partially flexing hips and knees exercise
secretions epidemics
- Entero virus (Poliovirus):  Painful IM injections or
• Difficult to make
Type 1 (Brunhylde) Spinal poliomyelitis: DPT (alum containing)
Basis for eradication: • Virus content >
Type 2 (Lansing) • Anterior Horn cells affected
 Man is the only host than OPV- costlier
Type 3 (Leon) Paralysis is: Disability limitation and
 Long term carrier state • No stringent
*Outbreaks of paralytic polio • Flaccid rehabilitation:
does not exist conditions for
due to Type 1 • Patchy and asymmetrical - Pts w/ muscle paralysis
 Effective live vaccine storage
• Descending benefit from frequent
 Vaccine mimics
Polio Myelitis Types of Polio: • Proximal muscles more passive range of motion
natural route of OPV (Sabin):
- Subclinical infections: 95% involved (PROM)
infection • Live virus
- Abortive poliomyelitis: 4-8% • Deep tendon reflexes are - Splinting of joints
 Displaces the wild • Orally
- Aseptic meningitis / diminished prevent contracture &
virus in intestines • Local, humoral &
nonparalytic polio: 1% • Sensory system intact joint ankylosis.
 If vaccination is 100% Herd immunity
- Paralytic poliomyelitis: < 1% - Chest physical therapy
there is abrupt Bulbar poliomyelitis: • Prevents intestinal
 Spinal (CPT)- pts w/ bulbar polio
interruption of • Medulla affected reinfection
 Bulbar and Bulbospinal prevents any pulmonary
transmission of wild • Facial asymetry (Cranial nv.) • Effective in
 Encephalitic complication (atelectasis)
polio virus • Difficulty in swallowing epidemics
- Occupational Therapy:
• Weakness or loss of voice • Easy to produce
pts w/ paralysis of
POC: 1-2weeks before • Death  respiratory • Cheaper
extremities: hand or arm
and after the onset of insuffeciency • Store: sub 0 temp
splints, knee or trochanter
illness
rolls, footboards, or Multi-
IP 7-14 days NO secondary
Podus boots (prevent foot
prevention
drop, ulcers, etc)
- Speech Therapy

- Vibrio Cholerae: - Case 1. Evacuation: - Oral Cholera


Cholera
- Group O1: “epidemic strain” - Subclinical cases: - Sudden onset of profuse, Vaccine (OCV)
- O139: New strain maintains endemic effortless, watery diarrhorea 2 doses 10-15 days
Lasanthi Aryasinghe -6-
- Killed by Gastric pH>=5 reservoir (Exotoxin H stimulates apart mix with
- Dose-related - Large dose - Vehicle Borne: Water, adenylate cyclase  cAMP 150ml safe H2O
11
required for infection 10 food, drinks  drives fluids and ions into the - Lasts 6 months
- Direct Contact- lumen of the small intestine) Treatment:
- Biotypes of O-Group 1: contaminated fingers  “Rice water stools” • Plan A – Home
- Classical - Feces, Vomit - Vomiting therapy fluids
- El Tor – greater “endemic - Formites
• Plan B – ORS
tendancy” than Classical 2. Collapse: • Plan C – IV fluids
- 3 serotypes: Carriers: - Rapid dehydration (+ acidosis
• Ogava - Temp: maintains reservoir  Death) ORS:
• Inaba - Chronic (Gallbladder - Muscular Cramps • NaCl - 3.5 mg/L
• Hikojima affected) - Suppression of urine ( renal • NaHCO3 -2.5mg/L
- Incubatory failure Death) or Trisodium citrate
- Convalescent - Unrecordable BP - 2.9 gm/L
- Healthy: imp in spread - Intense thirst • KCl - 1.5mg/L
- Sunken eyes • Glucose - 20mg/L
POC: • Water - 1 liter
Case- 7-10 days 3. Recovery: IV Fluids:
Convals. Carrier- 2-3 wks - Increased BP, urine flow • Ringers lactate
Chronic Carrier- 1mt-10yr
sol w/ 5% dextrose
Above are S/S of the Classical • Normal saline
type (5-10%) of Cholera, El Tor (Does not correct
types causes mild & inapparent acidosis)
infection
Chemotherapy:
• Doxycycline
IP few hours- 5 days • Tetracyclin
• Flurazolidine

- Salmonella Typhi - Man only reservoir 1. First stage (1 week) • Intestinal hmrrhge- 1 Prevention:
- Gram negative, nonsporing Temp  step-ladder fashion, sudden temp, shock,
- Facultative anaerobic rod - Case severe headache, malaise, dark/fresh blood in stool Health education:
- Secondary attacks may occur - Subclinical Case coated tongue, relative • Intestinal perforation Domestic, personal
- 3 main Ags- O, H & Vi: - Carriers: bradycardia, abd. pain & • Urinary retention & environ. hygiene
• Widal‟s Test for O, H, Vi Ags • Incubatory constipation • Thrombophlebitis
Typhoid &
• Ab to O Ag > in pt. w/ disease • Convalescent • Pychosis Vaccines:
Paratyphoid
• Ab to H Ag > in immunizd pts. • Chronic (>1yr) – 2. Second stage (1-2 weeks) • Nephritis • Vi polysaccharide
oraganism persists in • Fever reaches plateau • Osteomyelitis 1dose - parenteral
Paratyphoid fever: gallbladder & biliary tract • Abd. discomfort & distention • Cholecystitis
• S. paratyphi A & B (rare) • Fecal >urinary carriers • Pt. exhausted and prostrated • Hepatitis • Ty21a Oral live
• I.P. is shorter (Chronic urinary carriers • Diarrhea- pea soup stools • Fatty liver & abscess vaccine capsule
• Clinical manifestations- Milder are assoc. w/ urinary • Dicrotic pulse (double beat) • Bronchitis & pneumonia Day 1-3-5
• Complications – Uncommon tract abnormalities) • Occasionally meningismus • Myocarditis Booster evry 3yrs
Lasanthi Aryasinghe -7-
• Rose spots MORE • Female > Male carriers • Leukopenia • Meningitis
• Blood, urine & stools test +ve • Peritonitis 2 - Treatment:
- 1 source of infection: for salmonella • Ciprofloxacin
Feces & urine of carriers • Rose spots - 25% of white • Chloramphenicol
pts.- principally on trunk, fades • Cefexime
- 2 source of infection: on pressure • Amoxocillin
Contaminated water, • Splenomegaly & Toxemia • Cotrimoxazole
food, fingers & flies • Azithromycin
3. Third stage (over 7-10days) • Cortricosteroids –
Condition improves, temp  in  mortality in
step-ladder OR complications critically ill pts
start to appear
Chronic carriers:
4. Fourth stage: Recovery • Ampicillin plus
Relapse in 10-20% of cases Probenecid
• Cholecystectomy

IP 10-14 days; 3 days-3 weeks


IP is dose dependant
- Case
- Asymptomatic
(Anicteric) < children, Prevention:
maintains chain of trans. • NHIg -  Globulin
- Hepatitis A virus
- Feco-oral – food, water, - Given before
- Enterovirus
milk, raw / inadequetly exposure or
- Picornaviridae family
cooked shellfish Non-specific symptoms: during IP prevents
(cultivated in sewage Fever, chills, headache, fatigue, or attenuates
Serological Diagnosis:
water) , hands, eating generalised weakness, clinical illness but
• HAV particles or specific viral
utensils anorexia, nausea, vomiting, DOES NOT
Ags in feces
- Parenteral – blood & dark urine & jaundice prevent subclinal
Hepatitis A • Rise in anti-HAV titre – lifetime Primary Prevention:
blood products infection or
(infectious / persistance - Food hygiene
- Sexual – homosexuals, - Benign disease – recovery excretion of virus
epidemic • IgM appears early in illness - Supercholrination
oral-anal contact w/in a few weeks
jaundice) and persists for over 90days
• IgG appears more slowly, Vaccines:
- Fecal shedding > in • HepA Killed vacc.
persists for many years –
later part of IP and early IP 15 - 45days (usually 25- - 2doses parenteral
indicates past infection &
acute phase of illness 30days) – depends on dose - 6-18 months apart
immunity
ingested
- Feces, urine, blood, • Combined Killed
NO CHRONIC CARRIERS Hep A &
serum & other fluids are
infective during breif recombinant B
viremia - 3doses- 0-1-6 mts

POC: 2wks before – 1wk


Lasanthi Aryasinghe -8-
after onset of jaundice

- Hepatitis B virus
- Hepadna virus

3 morphological forms:
• Dane particles - 42nm
- Double shelled DNA virus
• Small spherical particles 22nm
- Antigenic, stimulate prod. of
surface Ag
- Purified 22nm particles used
to prepare Hep B vaccine
• Tubules of varying length

Serological Diagnosis: - Case Pre / Post Exp.:


HBsAg - Subclinical S/S similar to Hep A • HBIg – asap w/in
• Appears in serum during IP - Chronic carriers: - Complicated in the carrier 6rs & not >48hrs
before biochemical evid. of HbsAg > 9months state by chronic liver disease, - 2 doses – 30days
liver damage or jaundice 5-15% of cases; may which may follow infection apart
• Persists during acute illness cause chronic active Hep - Chronic liver disease may be
Hepatitis B - Hepatocellular cancer
• Cleared during convalesence & hepatocellular severe, and progress to primary • Hep B – Plasma
(Serum Hep) - Liver Cirrhosis
• Present for 4-6 months carcinoma liver cancer or cirrhosis derived vaccine
- 0-1-6 months
HBeAg - Contaminated blood
• Precedes onset of disease (main source), saliva, IP 6wks – 6 months (median • Hep B vac + HBIg
• Marker of virus replication, vaginal secretions & IP = 100 days)
therefore  infectivity semen
• Detectble 3-5days aftr HBsAg
• Persists 2-6 weeks
• Carriers - persists for yrs
• Presence of HBeAg indicates
pt. is highly infectious

HBcAg - Core Ag

Anti-HBs
• Indicates past infection &
immunity to HBV
• From HBIg or immune
response to HBV vaccine

IgM anti-HBc
Lasanthi Aryasinghe -9-
• Indicates recent infection
• Positive for 4-6 months
- Clinical illness is often mild,
usually asymptomatic
- Case - Chronic carriers are at risk of
- Chronic Carriers developing liver cirrhosis and
- 50% of cases are liver cancer
- Hepatitis C virus NO VACCINATION
Hepatitis C asymptomatic - Leading reason for liver
- Parenterally transmitted Non-
(Post - Transfusion transplantation - Hepatocellular cancer
A, Non-B (PT-NANB) Treatment:
Transfusion - Contaminated blood & - Liver Cirrhosis
- Single stranded RNA virus Interferon
Hepatitis) blood products - 50% of cases relapse when
- Similar to Flavivirus (Very expensive)
- Maternal – neonatal, treatment is stopped
sexual transmission is - Only 25% have long-term
small remission

IP 6 - 7 weeks

- Self-limiting acute viral hep for - Food hygiene


- Hepatitis E virus
a period of several wks followed precautions
- Enterically transmitted Non-A, Intrauterine infections w/
by recovery - Supercholrination
Non-B virus Hepatitis E:
- Water borne - Induces a fulminating form of - Recovery is
Hepatitis E - RNA virus: 29-32nm • Abortions
- Feco-oral acute disease in 80% of always complete
- Calcivirus • Intrauterine Death
pregnant women
• High perinatal M&M
NO SPECIFIC
NO CHRONIC CARRIERS
TREATMENT
IP 2-9weeks
- Hepatitis D virus
- Delta virus

Serological Diagnosis:
HDAg Immunization
• Detectable in early acute - ALWAYS occurs in assoc. w/ against Hep B also
Hepatitis D *See Hep B*
infection Hep B Carrier state protects against
delta infection
Anti-HDV
• Indicates past or present
infection

Group A - Group A beta hemolytic


Streptococcal - Streptococci M type:
infections 1,3,5,6,14,18,19 and 24
Lasanthi Aryasinghe - 10 -

ARTHOPOD-BORNE / ZOONOTIC / PARASITIC - INFECTIONS

Pre-exposure:
• 3doses- cell
Furious (classic) rabies culture vaccine
- Virus spreads from site of • 80% of cases • 0-7-21-(or) 28
infection centripetally via the • Death – few days • Booster after 2yrs
peripheral nerves towards the • Hyperactivity
CNS- it “ascends” • Hydrophobia Vaccine:
• Mood swings and • HDCV or PCECV
1. Prodormal stage: aggressiveness
Fever, malaise, headache, sore • Convulsions IM- 5doses x1ml
- Lyssa virus type I, RNA virus throat, tingling at site of bite Days: 0-3-7-14-28
Reservoir:
- Family Rhabdoviridae
- Urban Rabies Paralytic (dumb) rabies
- Street virus: naturally occuring • If previously vacc:
- Wild (Slyvatic) Rabies 2. Encephalitic stage: • 20% of cases Mild bites 1ml x 0-3
cases
- Bat Rabies Sensory  Motor  • Less dramatic form of
- Fixed virus: Serial brain-to- Severe 1ml x 0-3-7
Sympathetic  Mental the disease
brain passage of street virus in
- Animal bites - Intolerance to light, noise or • Death – 1 month ID- x 0.1ml
rabits; used to prepare
- Licks air (Aerophobia)- sensory • Flaccid muscle paralysis Days: 0-3-7-28-90
Rabies antirabies vaccine
- Aerosols – in bat caves - Increased reflexes, muscle develops early-
(Acute viral 2 x 0.1ml -Day0,3,7
- Person-Person: bites or spasms- motor prominent feature of this
encephalitis) Duration of illness:
- 2-3days
organ transplantation - Pupils dilated,  perspiration, form of rabies. Post-exposure:
salivation & lacrimation- • „Dumb‟ rabies reflects I No treatment
- Dead-end disease
- Carriers: only animals sympathetic the paralysis of the II Vaccine
(organism dies along with man)
- Fear of death, anger, laryngeal muscles which III Vaccine +Ig
- Virus evades the immune
Variable qty of virus in irritability, depression- mental inhibits speech.
system before the signs of
saliva of rabid animals  - Hydrophobia- sight or sound • Mild sensory • Clean- soap +H2O
encephalitis develops
only 50% of bites result in provokes voilent spasms of disturbances • Virucidal agent
rabies pharygeal and neck muscles • Avoid suturing
Treatment: • Antibiotics
3. Coma  Death • Isolation • Tetanus
• Sedatives • Ig 20 IU/kg -
IP 3-8wks or 7 days to years • Muscle relaxants infiltrated around the
depending on site & severity of • Hydration,diuresis wounds, remains given
bite, no. of bites and amount of • Resp & cardiac support at site anatomically
distant frm vaccine
virus injected • Barrier nursing
• Antirabies vaccine

- Plasmodium vivax - Female Anopheles 1. Cold stage – ¼ to 1 hr Falciparum:


- Plasmodium falciparum Mosquito takes blood Lassitude (fatigue), severe • Hyperparasitemia Treatment:
Maleria - Plasmodium ovale mealinjects sporozoites headache, nausea, rigors, • Hyperpyrexia • Day 1
- Plasmodium malariae - Blood transfusions Temp 39-40C, vomiting, skin • Severe anaemia Chloroquine +
feels cold initially hot, pulse is • Spontaneous bleeding Primaquin
Lasanthi Aryasinghe - 11 -
• Fetal Hb: supress Falciparum - Carriers: rapid & weak and coagulopathy • Day 2 & 3
• Sicklecell (AS Hb) trait: Human tht habor both • Cerebral malaria Chloroquine
Milder infection w/ Falciparum male & female sexual 2. Hot stage – 2 to 6 hrs (Convulsions, Coma)
• Duffy –ve: resistant to Vivax forms (gametocytes) of Pt feels burning hot- removes • Acute renal failure Vivax & Ovale:
sufficent density to infect clothing, skin hot & dry, intense (black water fever) • Primaquin (5days)
a vector mosquito headache, nausea dimishes, • Hypoglycemia
- Children are more likely pulse full, respiration rapid • Metabolic acidosis Chloroquin resist.
carriers than adults • Shock Faciparum:
3. Sweating stage – 2 to 4 hrs Artesunate plus:
- Definitive Host: Fever  w/ profuse sweating, Vivax, Ovale & Malariae: • Mefloquine
Mosquito, Sexual Cycle temp  rapidly to normal, skin is Anaemia, Splenomegaly • Amodiaquine
cool & moist, pulse decreases Liver enlargment, Herpes, • Sulfadoxine/
- Intermidiate Host: Renal complications Pyrimethamine
Man, Asexual Cycle
In pregnant women: Combined antimals
• Intrauterine death • More effective
• Premature labor • Prevent resistant.
• Abortion
• Congenital maleria Chemoprophylaxis:
• Cholorquin
1wk before travel to
4wks after return

Cutaneous forms: Control of reservoir:


• Skin ulcers on exposed areas, Early diagnosis:
face, arms and legs. • Aldehyde test
• Heals within a few months • ELISA
• Leaves scars • Isolation of
parasite from
Diffuse cutaneous forms: aspirates of
• Disseminated & chronic skin spleen, liver, bone
Vector Control:
lesions similar to lepromatous marrow, lymph
- Protozoa: Leishmania: • Elimination of breeding
- Bite: infected female leprosy nodes and skin.
L. donovani- Kala azar/Visceral places
Leishmania sandfly injects
L. tropica/ L. major- Cutaneous • Insecticide spraying
promastigotes Mucocutaneous forms: Treatment:
L. braziliensis- Muco cutaneous • Personal prophylaxis
• Lesions destroy mucous • Na stibugluconate
membranes of nose, mouth, 20days- Cutaneous
throat cavities & surrounding 28days - Visceral
tissues.
• Pentamidine
Visceral leishmaniasis: Isothionate- 10days
nd
• High fever, weight loss - 2 line drug
• Swelling of the spleen & liver
• Anaemia • Amphotericin B
Lasanthi Aryasinghe - 12 -
• Untreated fatality rate as high 7-14 days
as 100% within two years.

IP weeks-months
Prevention:
• Stiffness and cramps around DPT @ 2-4-6+
the area of wound 3 Booster doses:
• Deep tendon hyper-reflexia • DPT – 18 months
• Trismus lock jaw (masseters) • DT – 5-6yrs old
• Dysphagia • TT – every 10yrs
• Risus sardonicus (facial ms.)
• Opisthotonus (back and Post Exposure:
Introduction of spore  1. Clean wound, remove
neck)
germination & elaboration debris & dead tissues
• Painful paroxsymal spasms of
of exotoxin  blood 2. TIG/ATS +
- Reservoirs: soil, dust, voluntary muscles  cyanosis
stream  motor nerve Benzathine Penecillin
intestines of herbivorors  threatens resp. (long-acting) OR
endings  CNS via 3. TIG/ATS + TT (in pts.
(excreted in their feces)
- Clostridium tetani pheripheral nerves  w/ incomp. imunization)
- Contamination of Auntonomic dysfunction
- Gram +ve Blocks the release of + Benzathine Penecillin
wounds with tetanus (severe cases): 4. TIG/ATS + PTAP/APT
- Anerobic bacilli inhibitory (glycine)
spores - Toxin diffused to lateral horns (absorbd tetanus toxoid)
- Spore bearing neurotransmitters across +Benzathine Penecillin +
- Increased basal sympathetic
the synaptic cleft  TT (in 6wks) + TT (in
Types of Tetanus: tone: tachycardia, bowel &
Tetanus - Exotoxin tetanospasmin: Abolition of spinal 1yr)  in pts never been
• Traumatic - wounds bladder dysfunction
Acts on nervous system: inhibition  muscle immunized before
• Perpeural - postabortion - Sympathetic over activity
• Motor endplates- skeletal sys rigidity & spasms
• Otogenic - foriegn body (both alpha & beta receptors): Human Tetanus
• Spinal Cord
in ear • Labile hypertension HyperIg (TIG):
• Brain
• Idiopathic • Pyrexia • Human Antitoxin
• Sympathetic System Treatment:
• Neonatorum • Sweating • 250-500IU
• Isolation
• Pallor • No serum rxn
• Sedatives
POC: Not transmitted • Cyanosis of digits • Passive immunity
• Muscle relaxants
upto 30days
• Hydration,diuresis
• Exhaustion, asphyxia or
• Maintain adequet airway
aspiration pneumonia  Death Antitetanus Serum
(ATS):
• Equine Antitoxin
IP 6-10 days; depends on • 1500IU - SC
character, extent and location • Allergic reactions
of the wound. • Passive immunity
only 7-10days

- Retrovirus (lentivirus family) - Direct Contact: Sexually 1. Intial Infection Tests:


- RNA virus - Parenteral route Mild illness- fever, sore throat, Treatment:
AIDS • ELISA
- HIV-1 - Transplacental/ Vertical rash. Window Period – period Nucleoside Analog
- HIV-2 in West Africa - Blood Transfusions before HIV Abs (2-12wks) • Western Blot: • Zidovudine (AZT)
Lasanthi Aryasinghe - 13 -
- Occupational: needle- appear in blood after infection. Confirmatory Test. • Stavudine
stick injury Pt. is highly infectious due to Detects Ab to viral core • Lamivudine (3TC)
high viral conc. in his blood- pt. protien p24 & envelop • Didanosine
tests –ve on standard Ab tests. glycoprotien gp41.
Indeterminate results w/ Protease Inhibitors
Prophylaxis (4wks): 2. Asymtomatic Carrier state early HIV inf, HIV-2, • Saquinavir
• Zidovudine +Lamivudine No overt signs- only persistent Auto-immune disease, • Ritonavir
+ Nelfinavir (if source has AIDS) generalised lympadenopathy pregnancy & recent TT. • Indinavir
(nodes>1cm in 2 or more sites
• Stavudine + Didanosine • CBC – In advance HIV:
besides groin area for 3months) Nonnucleoside rev.
(if source failed AZT/3TC treatment) Anemia, neutropenia,
transcriptase inhbit.
Thrombocytopenia
3. AIDS related complex • Nevirapine
Vertical Transmission: 1 or more of: diahorrea>1mt, • Absolute CD4 count: • Delaviridine
• HAART during wt. loss>10%, fever, night AIDS – CD4<200cells/L
pregnancy sweats, oral thrush, enlarged FirstLine CD4 <500
• CD4 Percentage
• Perinatal Antiretroviral spleen, lympadenopathy. • 1 or 2 Nucleoside
prophylaxis AIDS – CD4 % <20% Analogs
• Caesarian section 4. AIDS • HIV Viral Loads:
• Ziduvudine to neonate • Opportunistic inf. + Cancers Amt. of actively Second Line
• Avoid breast feeding (Study table- infections related replicating virus. Relates • 1 Protease inhibit.
to falling CD4 count) to disease progression + 1 or more
• Slim disease - HIV wasting = and antiretroviral drugs. Nucleo. Analogs
Chronic diarrhoea + Wt. loss
POC: Highly infectious • AIDS dementia – HIV crosses • B2 Microglobulin levels: Third Line
>3.5mg/dL ass. w/ rapid
during „Window Period‟ BBB, resembles Alzheimer‟s • 1 or 2 Protease
progression of disease
and in advanced infection inhibit. + 1 or more
Nucl. Analogs
IP Few months to 10 years • Nevirapine +
Zidovudine +
Didanosine

• Swimmer’s Itch @ site Reservoir Control:


Urinary Complications:
- Blood Fluke/ Trematode • Katayama fever (serum •Praziquantel
• Hydroueter
sickness like syndrome) w/ •Mass chemotherpy
• Hydronephrosis
Urinary Schistosomiasis intestinal schistosomiasis, due for highrisk
• Cancer bladder
• S. haematobium to Ag-Ab complex children 10-15yrs
• Acute & Allergic manifestation •Artemether -
- Cercariae released by Intestinal Complications:
Schistosomia Intestinal Schistosomiasis • Characteristic manifestations anticercarial drug
snails  penetrate skin • Portal hypertension
• S. masonii occur after oviposition •Topical
• Liver cirrhosis
• S. japonicum. anticercarial
• Esophageal varicies
• S. Mekongi Urinary: ointment DEET
• Haematemesis
• S. intercalate Dysuria, terminal painless insecticide
• Colorectal polyps.
haematuria. Protienuria, repellent.
• Epilepsy (S. japonicum)
ulceration, thickening and
Lasanthi Aryasinghe - 14 -
calcification of urinary bladder Snail control:
• Mechanical
Intestinal: method- removal
Intermittent diarrhea, abdominal of aquatic
pain, melena, intestinal vegetations &
polyposis, hepatomegaly, increase flow of
spleenomegaly and ascites. water in canals
Manifestations more severe w/ • Biological
S. japonicum b/c no. of eggs. method- snail
eaters. Ducks and
geese
IP 2- 6 weeks • Chemical method-
molluscicides

A. Bubonic Plague
• Buboes - greatly enlarged,
tender lymph nodes in groin
area w/ erythema and edema
of the overlying skin. Formalin-killed:
Comlications of Bubonic:
• Fever, suddenchills, • 2doses SC
- Yersinia pestis • Natural reservoir: rodent • Secondary septicemia
• Day 0 & 14
- Gram-negative cocco bacilli • Source: infected rodents headache, prostration, painful • Pneumonia
• Booster evry 6mts
- Typical bipolar staining fleas & pneumonic case lympadenitis • Meningitis.
• If left untreated followed by • Immunity starts 5-
- Non-motile and non-sporing. • Vector: Most efficient • Polyarthritis
7days
vector is the rat flea disseminated infection  • Lung abscesses
• Infants <6mts not
Virulence due to: X.cheopis complications  secondary • Superinfection of lymph
immunized
• Exotoxin and endotoxin pneumonic plague & nodes
• Fraction 1 - Bite of infected flea meningitis. Bacteremia can
Treatment: 10days
• Many other Ag & toxins - Direct contact with occur, some develop sepsis Septicemic Plague:
Plague • Streptomycin
tissues of infected animal • DIC
• Tetracycline
Bacilli occur in: - Bite of human flea B. Pneumonic Plague • Menigitis x4 more
• Doxycycline
• Buboes- Cannot spread Pulex irritans from • Primary  inhalation of common than in bubonic
• Chloramphenicol
person-person as bacilli are plague pt. (rare) organism frm other humans • Multi organ failure
• Gentamicin
locked in buboe - Droplet infection: when • Seconday  hematogenous • Trimethoprim-
• Blood primary case of bubonic spread as a complication of sulfamethoxazole
• Sputum (pneumonic) plague develops pneumonic or bubonic plague IP
• Spleen, liver & other viscera of secondary pneumonic • Cough, hemoptysis, chest Bubonic 2-7 days
Prophylaxis:
infected pts plague pain, tachypnea and dyspnea Septicemic 2-7 days
• Tetracyclin
• Thin, watery, blood-tinged Pneumonic 1-3 days
• Sufonamide
sputum becomes frankly
bloody and mucopurulent as
the disease progresses.

C. Septicemic Plague
Lasanthi Aryasinghe - 15 -
• Primary- flea bite. S/S similar
to bubonic plague but
absence of palpable buboes.
• Secondary - complication of
pneumonic or bubonic plague.
• Some pts develop nausea,
vomiting, diarrhea & abd. pain.

- Wild reservoir: monkey


- Urban reservoir: Man &
Aedes aegypi mosquito 1. First phase: 72 hrs
Headache, malaise, weakness,
- Vector- Mosquito nausea and vomiting
Vector Control:
- Clinical cases
1. Anti larval measures -
- Subclinal cases 2. Remission: 24 - 48hrs
Apply larvicide to actual
17-D vaccine:
- RNA virus or potential breeding
- Jungle (Slyvatic) Cycle 3. Intoxication phase: 7-10day • Freeze-dried
- Family Togavirus places.
Transmission of disease • Jaundice w/ hemorragic • Reconstituted w/
- Flavivirus fibricus
b/w monkeys. manifestations; mucosal cold physiological
- group B Arbovirus 2. Anti adult measures -
Americas: Haemagogus hmrhgs & GI bleeding: black saline diluent
- Pantropic virus- can invade & Residual spray and space
Africa: Aedes africanus & vomit, epistaxsis and melena • Sub 0 temp
Yellow Fever affect different tissues of the sprays with insecticides
simpsoni • High fever • Immunity begins
body, w/out showing affinity to like malathion and
• Albuminuria or anuria- acute 7th day and lasts
any of them lindane.
- Urban Cycle renal failure >35yrs
- Shares specific Ag w/ other
Person to person • Shock • Revacination
members of the genus eg. West 3. Personal protection -
transmission by Aedes • Agitation every 10yrs
Nile & Dengue Mosquito repellants, nets,
aegypti mosquito • Stupor/ Delirium
coils and fumigation
• Seizures
mats.
POC: • Coma
-Man: blood of paitent • Death within 7-10 days
infective during first 3– 4
days of illness IP 3-6 days
- Mosquito: infective for
life