Control and Prevention of Communicable Diseases

 Acts as a physical and chemical barrier to infectious

There are generally two categories of diseases: agents
Communicable and Non- communicable
Being the first line of defense, the Innate Immune System
Communicable disease refer to types of diseases that can be contains Anatomical Barriers that prevent the entry of micro-
transmitted to humans either directly or through mediums. organisms.
Caused by microorganisms (bacteria, parasite, fungi, prion or
virus)

The Germ Theory explains that the growth and reproduction

of a micro-organism (germ) inside a human body can cause a
specific disease.

Pathogen - a disease causing microorganisms

A person's Susceptibility to the disease plus the

Pathogenicity of the microorganism can cause the risk of
having the disease.

Immune System
 The Human Body is equipped to defend itself from
these pathogens.

 defense mechanism Response to a PATHOGEN

2 Types of Immune System
a. Innate Immune System - non-specific and it does
not confer a long term immunity against a pathogen.
b. Adaptive Immune System - highly specific and it
creates a long term memory of immunity against
pathogens.
INNATE IMMUNITY
 usually the first line of defense. It is the first to respond
and it responds in more generic way.
 It has Humoral and Cell mediated immunity components
FUNCTIONS of Innate Immunity
 Recruiting immune cells to sites of infection, through the
production of chemical factors & specialized chemical
mediators called Cytokines,
 Activation of the complement cascade to identify
bacteria, activate cells & promote clearance of antibody
complexes or dead cells.
 Identification and removal of foreign substances by
specialized White blood cells.
 Activation of the Adaptive immune system through the
process of Antigen presentation.
antigen is defined as any substance that binds to a
specific antibody and elicits an adaptive immune
response
Inflammation - first reaction of the body as a response to
pathogen or antigen
Inflammation is characterized by
( 4 classic sign of Inflammation)
A. Erythema (Rubor) - redness of the skin
B. Increase local heat temperature (Calor)
C. Localized or generalized pain (dolor)
D. Swelling of tissue (tumor)
these inflammation is brought by reactions of macrophages,
dendritic cells} histiocytes mastocytes
On the surface of these cells are receptors called Pattern
recognition receptors which recognize certain molecules
present in all pathogens but not present in the host's cells.
INNATE IMMUNE SYSTEM - WHITE BLOOD CELLS /
LEUKOCYTES
LEUKOCYTES FUNCTION
Neutrophil Most abundant form of phagocyte,
first to go to the site of inflammation
of infection (Phagocytic)
Dendritic Cell Mostly present in tissues that are
exposed to external environment
(skin, mucosa). It serves as the link
between the innate & adaptive
immune system (phagocytic)
Basophil Releases histamine in response to a
parasitic infection
Eosinophil Releases toxic molecules in response
 to a bacterial and parasitic infection B lymphocytes are the predominant cells involved in the
may damage tissue creation of Immunoglobulins (lg) or Antibodies.
Mast Cell Releases heparin, histamines,
chemokines, chemotaxic cytokines. The production of antibodies is a process occurring in a
Involved in allergic reactions or humoral immunity response
anaphylaxis & wound healing.
Macrophage Phagocytic cells which can move
across the walls of capillary vessels. There are five antibodies or Immunoglobulins:
Natural Killer Cell Destroys compromised host cells such Immunoglobulin (lg) Description
as virus-infected cells or even tumor IgG majority of antibody based
cells. immunity against
pathogens; can cross to
When a pathogen is able to evade the Innate Immune placenta
System, the Adaptive Immune System takes over. IgA found in mucosal areas
(gut, respiratory tract &
Adaptive Immunity urogenital tract, saliva,
 provides a long term protection to the host against tears, breast milk) prevents
pathogens, the colonization of
pathogens.
 cells involved are LYMPHOCYTES (B cells & T cells) IgM Eliminates pathogens in the
early stages of B cell
 for IMMUNIZED individual, this triggers the portion of mediated immunity before
Adaptive immunity. there is sufficient lgG
IgE Binds to allergens & triggers
The Adaptive Immune System has at least three major histamine release from
functions: mast cells & basophils;
involved in allergy and
1. Recognition of specific "non-self" antigens in the parasitic infections.
presence of "self", during the process of antigen IgD Acts as antigen receptor on
presentation. B cells that have not been
exposed to antigens.
2. Generation of responses that are tailored to maximally
eliminate specific pathogens or pathogen-infected cells.
Major Histocompatibility Complex (MHC)
3. Development of immunological memory, in which
pathogens are "remembered" through memory B cells  MHC group of genes that code for proteins found on the
and memory T cells. surfaces of cells that help the immune system recognize
foreign substances.
ADAPTIVE IMMUNE SYSTEM - T LYMPHOCYTES
 once B cell encounters its specific antigen & receives
T LYMPHOCYTES FUNCTION additional signals from a helper T cell, it further
T helper cell Also known as CD4+ Cells, secretes differentiates into an effector cell known as Plasma cell
cytokines, assist in the maturation of (short lived cells 2-3 days secretes antibodies)
B-cells, activates cytotoxic T cells and
macrophages  Passive memory (short term) - ex. when maternal lgG is
Cytotoxic T cell Also known as CD8+ T cells, destroys transported directly across the placenta.
virus-infected cells
Memory T cell Gets activated upon re-exposure to a  Active memory (long term) - ex. process of immunization
cognate antigen, can either be CD4+ artificially activates cells & produce an active
or CD8+ immunological memory against a select group of
Suppressor T cell Shuts down T cell-mediated immunity pathogens.
toward the end of an immune
reaction When B cells and T cells are activated some will become
Natural killer T Produces cytokines and cytolytic (cell memory B-cells and some memory T-cells
cell destroying) molecules
IMMUNIZATION

Immunoglobulins (lg)
 Is the process which a person is made immune or
resistant to an infectious disease. BACTERIA
CAUSATIVE AGENT DISEASE
 Principle: is to introduce an antigen derived from a Clostridium botulinum Botulism
disease causing organism, that stimulates the immune Leptospira Weil's disease (Leptospirosis)
system to develop protective immunity against Clostridium tetani Tetanus
organisms but that does NOT itself cause the pathogenic Mycobacterium tuberculosis Tuberculosis
effects of that organisms. Salmonella typhi Typhoid fever
Corynebacterium diptheria Diptheria
Staphylococcus aureus Impetigo
There are two basic types of vaccines: live attenuated and
Mycobacterium leprae Hansen's disease (Leprosy)
inactivated Neiserria gonorrheae Gonorrhea
Streptococcus Rheumatic fever
1. Live attenuated Bordetella pertusis Whooping cough (pertussis)
 produce by modifying a disease producing (wild) Vibrio cholerae
virus or bacteria. Retains the ability to replicate &
produce immunity.
VIRUS
 "Wild" form do not cause disease CAUSATIVE AGENT DISEASE
Hepatitis virus Hepatitis
 " Milder" form cause disease but it is only an Dengue (Flavivirus) virus Dengue hemorrhagic fever
Adverse reaction Rabies (Rhabdovirus) virus Human Rabies
papillomavirus Warts
 Measles, mumps, rubella, varicella, rotavirus & Human immunodeficiency virus Acquired immunodeficiency
influenza, oral polio, Bacille Calmete Guerin (BCG), syndrome
oral typhoid vaccines.
Measles (Paramyxovirus) virus Rubeola (Measles)
2. Inactivated - can be composed of either whole viruses or Mumps (genus Rubulavirus) virus Epidemic parotitis (Mumps)
Polio (genus Enterovirus) virus Poliomyelitis
bacteria or fractional (protein or polysaccharide based)
Rotavirus Severe diarrhea
Varicella zoster virus Chicken pox, shingles
 can be composed of either whole viruses or bacteria German measles
Rubella (genus Rubivirus) virus
or fractional (protein or polysaccharide based). Infectious mononucleosis
Eipstein-Barr virus

 not alive and cannot replicate,

 requires multiple dose

PARASITE

 the 1st dose does not produce protective immunity, CAUSATIVE AGENT DISEASE
only In 2nd or 3rd dose, booster Entamoeba histolytica Amebiasis
Ascaris lumbricoides Ascariasis
Diphyllobothrium latum Diphyllobothariasis
 Inactivated whole vaccines Hepatitis A, Rabies (viral) (Tapeworm infection) Cutaneous
Ancylostoma brazilense larva migrans
 Inactivated whole vaccines : Pertussis, typhoid, cholera, Filariasis (elephantiasis)
Wuchereria bancrofti
plague (bacterial) Plasmodium sp. Malaria
Schistosoma sp. Schistosomiasis (bilharzia)
 Fractional vaccines : Hepatitis B, Influenza, Acellular Trichuris trichiuria Whipworm infection
pertusis, Human papillomavirus (HPV), Anthrax, Taenia sp Tapeworm infection,
cysticercosis
Diptheria, Tetanus
Fungi
 Polysaccharide vaccine : Pneumococcal disease,
Meningococcal disease, Salmonella Typhi, Haemophilus CAUSATIVE AGENT DISEASE
Candida albicans Candidiasis (thrush, genital )
Cryptococcus neoformans Cryptococcosis
(unique type of inactivated subunit vaccine com posed of long
Dermatophytes Ringworm
chains of sugar molecules that make surface capsule of Trichophyton sp. Tinea pedis (athlete's foot)
certain up the bacteria )

Inactivated vaccines always require multiple doses. In

BACTERIA
general, the first dose does not produce protective immunity,
but "primes" the immune system.
 Prokaryotic microorganisms (cells lack a nucleus and Cell membrane - aka. plasma membrane, acts as barrier to
other organelles) hold nutrients, proteins

 morphologies: rod-shaped, spherical, curved, square or Nucleiod - an irregularly-shaped region within the cell of a
star shaped and forms chains or clusters or pairs. prokaryote that contains all or most of the genetic material.

 movement mechanisms: swim (flagella), gliding & Capsule- usually a hydrated polysaccharide structure that
twitching motility. covers the outer layer of the cell wall,

 bacterial infections may be treated with Antibiotics, Cell wall - are made of peptidoglycan (also called murein),
which are classified as Bacteriocidal if it kills bacteria and which is made from polysaccharide chains cross-linked by
if it is just to prevent bacterial growth called unusual peptides containing D-amino acids, in addition to
Bacteriostatic. providing overall strength to the cell.

BACTERIAL MORPHOLOGY Mesosomes - help in cell wall formation. They also help in
DNA replication and distribution to daughter cells. They help
in respiration, secretion and to increase the surface area of
the plasma membrane and the enzyme content

Ribosomes - function as a workbench for protein synthesis

whereby they receive and translate genetic instructions for
the formation of specific proteins.

Cytoplasm or protoplasm - of bacterial cells is where the

functions for cell growth, metabolism, and replication are
carried out. It is a gel-like matrix composed of water,
enzymes, nutrients, wastes, and gases and contains cell
structures such as a ribosomes, a chromosome, and plasmids.

Flagella -help an organism in movement. They act as sensory

organs to detect temperature and pH changes.

Structures
Bacteria can be classified according to how they respond to
Gram staining. The thick layers of peptidoglycan in the
"Gram-positive" cell wall stain purple, while the thin "Gram-
negative" cell wall appears pink.
Some organisms are best identified by stains other than the
Gram stain, particularly Mycobacteria or Nocardia, which
show acid-fastness on Ziehl-Neelsen or similar stains.
VIRUS
 smaller than a bacteria, even can infect bacteria and
other microorganisms
 made up of 3 major components
 Genetic material (either from DNA of RNA)
 Protein coat protects the genetic material
 Envelope of lipids surround the protein coat
Antigenic shift - occurs when there is a major change in the
genome of the virus, this can be a result of recombination of
reassortment when this happens with influenza viruses
Pandemic might the result.
VIRAL SHAPES
 Helical - composed of single type of capsomer stacked
around a central axis to form a helical structure w/c may
have a central cavity or tube.
 Icosahedral (polyhedral) viruses are composed of 20
faces.
 Spherical - are ball shaped, also referred to as
"envelope", surrounds or encased of bilayer membrane
 Complex - head-tail morphology structure which can
infect bacteria known as "Bacteriophages"
How they assemble
1. Attachment - specific binding between viral capsid proteins
& specific receptors on the host cellular surface.
2. Penetration - virions enter to the host cell through receptor
mediated endocytosis or membrane fusion.
3. Replication - Involves the synthesis of viral messenger RNA
(mRNA) from early genes, viral protein synthesis, possible
assembly of viral proteins, then viral genome replication
mediated by early or regulatory expression.
4. Release - viruses can be released from the host cell by lysis,
a process that kills the cells by bursting its membrane.
Parasites
 non-mutual symbiotic relationship with their host.
 do not kill their host, are generally much smaller
than their host, and will often live in or on their host
for an extended period.
THREE MAIN CLASSES OF PARASITES THAT CAN CAUSE
HUMAN DISEASES
a. Protozoa
 microscopic, one-celled organisms that can infect
and multiply in human beings.
 abundant in aqueous environments and soil,
occupying a range of trophic levels.
The group :
 flagellates (which move with the help of whip-like
structures called flagella)
 ciliates (which move by using hair-like structures called
cilia)
 amoebae (which move by the use of foot-like structures
called pseudopodia).
 Some protozoa are sessile, and do not move at all.
The protozoa that are infectious to humans can be classified
into four groups based on their mode of movement:
1. Sarcodina e.g. ameba
2. Mastigophora also known as the flagellates
3. Ciliophora or the ciliates
 4. Sporozoa e.g. Plasmodium and Cryptosporidium
b. Helminths
 large, multicellular organisms that are generally
visible to the naked eye in their adult stages.
 either free-living or parasitic in nature. In their adult
form, helminths cannot multiply in humans.
There are three main groups of helminths that are human
parasites:
1. Flatworms or platyhelminths include nematodes
and cestodes
2. Acanthocephalins-also referred to as thorny-headed
worms
3. Roundworms the adult forms of these worms can
reside in the gastro intestinal tract, blood, lymphatic
system or sub- cutaneous tissues.
these organisms are not typically considered parasites.
the immature (larval) states can cause disease through
their infection of various body tissues.
segmented worms (annelids) the only ones important
medically are the leeches.
Helminthiasis
 An infection by a helminth
 soil-transmitted helminthiasis, helminth infection or
intestinal worm infection.
Helminths
 worm- like organisms living in and feeding on living
hosts, receiving nourishment and protection while
disrupting their hosts' nutrient absorption, causing
weakness and disease.
Intestinal parasites
 Those that live inside the digestive tract
 They can live inside humans and other animals. In
their adult form, helminths cannot multiply in
humans.
TRANSMISSION
Direct contact transmission - spread of infectious organisms
from the skin or one person directly to another person.
Indirect contact transmission - spread of infectious
organisms by coming into contact with a contaminated object
& then brining the germ into the body.
Airborne transmission - spread of infectious organisms
through the air, organisms can survive in air for long period of
time.
Blood borne transmission - spread of infectious organisms
through direct blood to blood contact,
Droplet transmission - spread of infectious organisms from
infected person in tiny droplets to fluid that can travel small
distance (less than one meter)
Sexual contact transmission - spread of infectious organisms
from infected person to another person through sexual
contact (vaginal or anal sex
The infectivity or the ability of the organism to enter and
replicate in the host depends on three major factors: the
nature of the organism or agent or pathogen
The interaction of these three factors is also referred to as
the epidemiological triangle.
 Nature of the agent refers to the pathogenicity of
the organism or its capability to cause disease in a
host
 Nature of the host refers to the(susceptibility of the
host to develop the disease caused by the agent.
 Environment refers to factors that either inhibit or
promote disease transmission

c. Ectoparasites
 can include the Blood sucking arthropods such as
mosquitoes because they are dependent on a blood
meal from a human host for their survival,
 ticks, fleas, lice & mites
 Arthropods are important in causing diseases in their
The absence of just one of the three factors implies that no
own right, causes morbidity and mortality.
disease can occur in a person. Thus, in controlling or
preventing the occurrence of communicable or infectious
IMPLICATIONS IN PUBLIC HEALTH
diseases, public health interventions can focus on one of the
 It is important to categorize the type of communicable
three factors.
diseases,
 categorized based on the duration of diseases,
For Example, public health interventions can focus on the
 Acute , if lasts for less than 3 months,
host by increasing immunity of the host against the agent
 Chronic if lasts for more than 3 months
either through immunization or increasing nutrition to boost
 if a person who has a disease or infection it is referred as
the immune system.
CASE.
Wearing of protective barriers of the host that would prevent
contact with the agent can disrupt transmission of the disease
from the environment or from one person to another.
Public health interventions can focus on the agent by
production of antibiotics or anti-viral drugs that would
specifically target the organism.
These drugs disrupt the replication of the organisms
therefore prohibiting them from increasing their capacity to
cause disease in a person. The creation of vaccines is also a
public health strategy specifically addressing the agent or
pathogen. In
incubation period- the time between when the host is
infected and when disease symptoms occur.
One of the goals of public health is to interrupt the
transmission of infectious diseases within the population.
CHAIN OF INFECTION MODEL
visualize the step-by-step process by which communicable
diseases spread from an infected person to an uninfected
person in the community.

Vectors
is a pathogen that carries and transmits an infectious
pathogen into another living organism.

Vector- borne diseases

Diseases that require the presence of a vector
COMPONENTS OF CHI
Arthropods form a major group of disease vectors.
The pathogenic agent leaves its reservoir (infected host) via a
Examples of which are mosquitoes, flies, lies, ticks and mites.
portal of exit. Transmission occurs in either a direct or
Many of them are hematophagous or "blood feeders" and
once they feed on blood, they inject the pathogen into the indirect manner, and the pathogenic agent enters a
bloodstream of the host. susceptible host through a portal of entry in order to
establish disease.
Here are some EXAMPLES OF VECTOR-BORNE DISEASES
especially common in the Philippines: the reservoir for a disease may be a case or a carrier-one who
is well but infected and is capable of serving as a source of
Disease Vector Causative Agent infection.
Dengue Aedes mosquito Denque virus
A carrier could be one who is incubating the disease (e.g.
(Flavivirus)
person who is HIV positive but has not signs of AIDS) or one
Malaria Anopheles Plasmodium
who has recovered from the disease (is asymptomatIc), as is
mosquito
sometimes the case in typhoid fever.
Chikungunya Aedes mosquito Chikungunya
virus (Alpha virus)
For some diseases, the reservoir is not humans but animals.
Lymphatic Variety of Wucheria
Diseases for which the reservoir resides in animal populations
filariasis mosquitoes bancrofti, Brugia
are called zoonoses. Plague and rabies are zoonoses.
malayi, Brugia
timori
Diseases for which humans are the only known reservoir, like
Japanese Mosquitoes IE virus measles, are known as anthroponoses.
encephalitis
Schistosomiasis Freshwater snails Schistosoma sp. The goals of epidemiology are to prevent, control, and in rare
cases, to eradicate diseases and injuries.
Vector control
one public health strategy in order to disrupt transmission of Prevention implies the planning for and taking of action to
these types of diseases. prevent or forestall the occurrence of an undesirable event,
and is therefore more desirable than intervention, the taking
Time of action during an event.
 "fourth" factor in this epidemiological triangle. For example, immunizing to prevent a disease is
 the Center of the Triangle. preferable to taking an antibiotic to cure one.
 the duration the illness or the amount of time a person
can be sick before death or recovery occurs. Control is a general term for the containment of disease and
 the period from an infection to the threshold of an can include both prevention and intervention measures.
epidemic for population The term control is often used to mean the limiting of
transmission of a communicable disease in a population.
Eradication is the uprooting or total elimination of a disease
from the human population. It is an elusive goal, one that is
only rarely achieved in public health.
Smallpox is the only communicable disease that has
been eradicated.
PREVENTION AND CONTROL EFFORTS FOR COMMUNICABLE
DISEASES
a. Primary prevention is to forestall the onset of illness or
injury during the pre-pathogenesis period (before the
disease process begins).
Examples
 health education and health promotion programs
 safe-housing projects
 character-building
 personality development programs
 immunizations against specific diseases
 practice of personal hygiene
 chlorination of the community's water supply.
b. Secondary preventive measures against communicable
diseases for the individual involve either
1) self-diagnosis and self-treatment with
nonprescription medications or home remedies
2) diagnosis and treatment with an antibiotic
prescribed by a physician
Examples
aimed at controlling or limiting the extent of an epidemic.
 carefully maintaining of records of cases
 complying with the regulations requiring the
reporting of notifiable diseases
 investigating cases and contacts
 isolation and quarantine.
c. Tertiary preventive measures for the control of
communicable diseases for the individual include
convalescence from infection, recovery to full health, and
return to normal activity.
In some cases. such as paralytic poliomyelitis, return to
normal activity may not be possible even after extensive
physical therapy.
Example
are aimed at preventing the recurrence of an epidemic
 The proper removal, embalming, and burial of the
dead.
 re-application of primary and secondary measures in
such a way as to prevent further cases.
TUBERCULOSIS
 is caused by a bacterium called Mycobacterium
tuberculosis,
 TB bacteria usually attack the lungs, but can attack
any part of the body such the kidney, spine, and
brain.
 spread through the air from one person to another
when a person coughs, sneezes, speaks, or sings.
 People nearby may breathe in these bacteria and
become infected.
 Organisms are Aerobic in nature
Symptoms of active TB patients: cough, sometimes with
blood, chest pains, weakness, weight loss, fever & night
sweats.
LABORATORY
waxy coating on its cell surface (primarily due to the presence
of mycolic acid)
Acid fast bacilli (Ziehl Neelsen) - direct sputum smear
microscopy (DSSM)
Case finding is the identification and diagnosis of TB cases
among individuals with signs and symptoms presumptive of
tuberculosis.
The available tests utilized by the program for diagnosing TB:
 direct sputum smear microscopy
 TB culture
 drug susceptibility test
 tuberculin skin test
 rapid molecular diagnostic tests
Direct sputum smear microscopy (DSSM) is fundamental to
the detection of infectious cases and is recommended for
case finding among adults and children who can expectorate.
1. It provides a definitive diagnosis of active TB;
2. The procedure is simple;
3. It is economical;
4. A microscopy center could be put up even in remote
areas.
DSSM serves as one of the bases for categorizing TB cases
according to standard case definition.
a) monitor progress of patients with TB while they are
on anti- TB treatment;
b) confirm cure at the end of treatment
Chest X-ray is used to complement bacteriologic testing in
making a diagnosis. However, it has low specificity and does
not differentiate drug-susceptible from drug-resistant
disease.
TB-culture and drug susceptibility test (DST) using solid
(Ogawa or Lowenstein Jensen) or liquid media (MGIT) is a
routine diagnostic test for drug-resistant TB cases under the
NTP.
DSSM RESULTS AND INTERPRETATION

Tuberculin skin test (TST) aka. PPD test or Mantoux test
 basic screening tool for TB infection among children using
purified protein derivative (PPD)
tuberculin solution to trigger a delayed hypersensitivity
reaction among those previously infected.
Rapid molecular diagnostic tests endorsed by the WHO will
be utilized by the NTP. WHO endorsed available diagnostic
tests in the country are Xpert MTB/RIF and Line-Probe Assay
(LPA) for first line drugs.
Xpert MTB/RIF assay is a rapid test that detect
Mycobacterium tuberculosis and Rifampicin resistance.
CASE FINDING
 Passive case finding - symptomatic patients are screened
for disease activity upon consultation at the health
facility
 Active case finding - is a health worker's purposive effort
to find TB cases in the community or among those who
do not consult with personnel in a DOTS facility.
 Intensified case finding - is active case finding among
individuals belonging to special or defined populations
(close contact, high risk clinical group & high risk
populations)
1. Close contact - A person who shared an enclosed
space, such as the household, a social gathering
place, workplace or facility, for extended periods
within the day with the index case during the
months before commencement of the current
treatment episode.
2. High-risk clinical groups - Individuals with clinical
conditions that put them at risk contracting TB
disease, particularly those with immune
compromised states.
(e.g., HIV / IAIDS, diabetes, end-stage renal disease,
cancer, connective tissue diseases, autoimmune diseases,
silicosis, patients who underwent gastrectomy or solid
organ transplantation and patients on prolonged
systemic steroids).
3. High-risk populations- Persons with known high
incidence of TB, particularly those in closed
environments or living in congregate settings that
promote easy disease transmission (e.g., inmates,
elderly, Indigenous Peoples, urban/rural poor).
TB DISEASE CALSSIFICATION
a) Bacteriologically- confirmed a TB patient from whom a
biological specimen is positive by smear microscopy,
culture or rapid diagnostic tests (such as Xpert MTB/RIF).
b) Clinically-diagnosed - A PTB patient who does not fulfill
the criteria for bacteria logical confirmation but has been
diagnosed with active TB by clinician or other medical
practitioner who has decided to give the patient full
course of TB treatment.
TB DISEASE CALSSIFICATION:
a. Pulmonary TB (PTB) Refers to a case of tuberculosis
involving the lung parenchyma, A patient with both
pulmonary and extra-pulmonary TB should be classified
as a case of pulmonary TB.
b. Extra-pulmonary TB (EPTB) - Refers to a case of
tuberculosis involving organs other than the lungs (e.g.,
larynx, pleura, lymph nodes, abdomen, genitourinary
skin, joints and bones, meninges).
TB CASE
New case - is a patient who has never had treatment for TB
or who has taken antiTB drugs for less than one month.
Retreatment case - is any patient who has been previously
treated with anti-TB drugs for at least one month in the past.
Case holding- is the set of procedures which ensures that
patients complete their treatment .Case holding involves
assignment of the appropriate treatment regimen based on
diagnosis and previous history of treatment.
Directly Observed Treatment (DOT) -is a method developed
to ensure treatment compliance by providing constant and
motivational supervision to TB patients.
DOT works by having a responsible person, referred to as
treatment partner, watch the TB patient take anti-TB drugs
every day during the whole course of treatment.
 Growing consensus indicates that progress in tuberculosis
control in the low- and middle-income world will require not
only investment in strengthening tuberculosis control
programs, diagnostics, and treatment but also action on the
social determinants of tuberculosis.

the population distribution of TB reflects the distribution of

these social determinants, which influence the 4 stages of TB
pathogenesis: exposure to infection, progression to disease,
late or inappropriate diagnosis and treatment, and poor
treatment adherence and success
TWO TYPES OF DRUG TREATMENTS FOR TB:

1. Fixed-dose combination (FDCs) - Two or more first-line

anti-TB drugs are combined in one tablet. There are 2-,
3-, or 4-drug fixed-dose combinations, namely: Isoniazid-
Rifampicin (HR), Isoniazid-Rifampicin-Ethambutol (HRE)
and Isoniazid-Rifampicin-Pyrazinamide-Ethambutol
(HRZE).

2. Single drug formulation (SDF) Each drug is prepared

individually, either as tablet, capsule, syrup or injectable
(Streptomycin) form.

TREATMENT REGIMEN FOR ADULTS AND CHILDREN

MALARIA
 parasitic infectious disease caused by protozoan
parasites of the genus Plasmodium and is
transmitted by mosquitoes.

 It is characterized by recurrent symptoms of chills,

fever and generalized body pain.
DRUG DOSAGE PER KILOGRAM BODY WEIGHT

FOUR PLASMODIUM SPECIES OF HUMAN MALARIA:
P. falciparum
 found worldwide, mainly in tropical and subtropical
areas.
 main species that causes severe, potentially fatal malaria
P. vivax
 Found mainly Asia, Latin America, and in some parts of
Africa.
 cause severe illness.
 does not infect individuals who are negative for the Duffy
blood group, as are many residents of sub-Saharan Africa
(merozoite  ring stage mature trophozoite  schizont
 merozoites schizont  merozoites)
 leading to invasion of more red blood cells.
 Some intraerythrocytic parasites develop into the sexual
forms, the gametocytes;
Gametocytes
When potent gametocytes are ingested by a female
Anopheles mosquito during a blood meal, micro- and
macrogametocytes mature to become male and female
gametes.
TERMINOLOGIES
Endemicity - malaria describes the intensity of malaria
transmission in a given community or region can be classified
according to parasite rates.

P. ovale
 Dormant liver stages, the hypnozoites, which can Stable malaria areas - In these regions:
become activated and invade the blood to cause clinical  transmission occurs all year round, though there may be
relapse several months or years after the infecting seasonal variations;
mosquito bite.  older children and adults in the community have partial
immunity which protects them from severe forms of
P. malariae malaria;
 found worldwide.  young children are susceptible to severe malaria.
 causes a persistant chronic infection which may be
lifelong. Unstable malaria areas - In areas with low transmission:
 patients develop serious complications such as the  intermittent transmission may be annual, biannual (twice
nephrotic syndrome. a year) or variable;
 malaria epidemics tend to occur;
PROCESS  immunity to malaria is usually low or absent.

Sporozoites Uncomplicated malaria

 Humans acquire malaria transmitted by the bite of an
infected female anopheline mosquito.
 travel through the bloodstream to the liver within about
30 minutes, where they invade hepatocytes and mature
to be-come tissue schizonts (pre-erythrocytic
schizogony).
symptomatic malaria with parasitaemia without signs of
severity or evidence of vital organ dysfunction.
The main manifestations of uncomplicated malaria include
fever, chills, rigors, headaches, and body pains. Others are
malaise, nausea, vomiting, and joint weakness

Tissue schizonts Physical examination may reveal pallor and

 Central feature of all plasmodium species that infect hepatosplenomegaly.
humans.
 They amplify the infection by producing large numbers of Severe malaria
merozoites (10 000 30 000) from each sporozoite- refers to acute P.falciparum malaria with signs of severity or
infected hepatocyte. evidence of vital organ dysfunction.

Merozoite A patient is regarded as having severe falciparum malaria if

 Each released from the liver is capable of infecting a there are asexual forms of falciparum in a blood film and any
human red blood cell (RBC) of the following clinical or laboratory features.
 establishing the asexual cycle of replication in the red
blood cells. Non-specific
This means that many other infections can cause signs and
Asexual cycle symptoms identical to those caused by malaria.
 starts with merozoite invasion and continues to schizont
rupture Parasitological diagnosis
required for confirmation of the diagnosis of malaria is
recommended for all suspected malaria cases in all
transmission settings.
LABORATORY
Types of stains
Romanowsky stains
 stain the nucleus red and cytoplasm blue have
proved the most.
 Adoptable and reliable for routine work.
Giemsa stain (thick and thin blood smear)
 An alcohol based Romanowsky stains
 golden standard
 It is the most commonly used stain and the best for
routine diagnosis due to its applicability to both thick
and thin blood films
Field stain
 most widely used aqueous-based stain
 is a good method to stain thick smears but not
suitable for thin smears.
 film is stained extremely quick.
Leishman's stain
solution which uses methanol as solvent and therefore, useful
to stain thin smears
Wright's stain
used if rapid results are needed but it is not optimal for blood
parasites.
Note: thick smears are more sensitive for detecting presence
of parasites, thin smears can provide more details for species
determination.
Malaria rapid diagnostic tests (RDTs)
 detect malaria-specific antigens derived from the
blood stages of a malaria parasites.
 The presence of antigen is indicated by a result line
across a nitrocellulase strip.
 detecting falciparum ty and vivax malaria are
comparable to field microscopy.
The commercially available RDTs target the plasmodium
falciparum
 Histidine-Rich Protein (HRP2),
 plasmodium lactate dehydrogenase (pLDH)
 aldolase (common to all malaria species).
Different variants of pLDH are present in the commercially
available RDTs:
o pLDH-Pan (common to all human malaria species),
o pLDH-Pf (present only in P. falciparum),
o pLDH-Pv (present only in P. vivax)
o pLDH-Pvom (present in all species except P. falciparum)
TREATMENT
Uncomplicated Falciparum malaria
 Artemther plus lumefantrine
20mg of artemether and 120mg of lumefantrine
 Artesunate plus amodiaquine
25/67.5, 50/135 or 100/270mg of artesunate and
amodiaquine
 Artesunate plus mefloquine
50mg of artesunate and 250mg of mefloquine
 Artesunate plus sulfadoxine-pyrimethamine
50mg of artesunate and 500mg of sulfadoxine and 25mg
of pyrimethamine.
 Dihydroartemisinin plus piperaquine
40mg of Dihydroartemisinin and 320mg of piperaquine.
 use of Antipyretics
Fever is a cardinal feature of malaria. Paracetamol should
be used
 use of Anti-emetics
Vomiting is common in malaria and anti-emetics are
frequently prescribed.
 Management of convulsions
Generalized seizures (intramuscular paraldehyde, or
rectal or parenteral benzodiazepine).Multiple
convulsions are a sign of severe malaria.
Uncomplicated Non- Falciparum malaria
Oral chloroquine
 For chloroquine-sensitive vivax malaria
 (Chloroquine, Chloroquine + proguanil, Atovaquone-
proguanil, doxycycline or mefloquine)
Prophylaxis against malaria
 chemoprophylaxis
 resistance to antimalarial medicine: chloroquine,
chloroquine plus proguanil, mefloquine, or
doxycycline
Chloroquine alone can only be recommended for areas
where malaria is due exclusively to P. vivax or fully
chloroquine-sensitive P. falciparum.
Chloroquine + proguanil can be recommended for areas
where both P. vivax and P. falciparum malaria transmission
co-exist and where chloroquine resistance is emerging.
Atovaquone-proguanil, doxycycline or mefloquine (selected
according to reported resistance pattern) are recommended
for areas with high risk and moderate/low of P. falciparum
PREVENTION
Insecticide-treated bed nets (ITNs)
form of personal protection that has been shown to reduce
malaria illness, severe disease, and death due to malaria in
endemic regions.
pyrethroid insecticides
approved for use on ITNs
These insecticides have been shown to pose very low health
risks to humans and other mammals
DENGUE FEVER/ DENGUE HEMORRHAGIC FEVER
Dengue Fever is a disease caused by any one of five closely
related dengue viruses
(DENV I, DENV 2, DENV 3, DENV 4 or DENV5).
 transmitted to people by the bite of an Aedes
mosquito that is infected with a dengue virus.
 symptoms: high fever, severe headache, severe pain
behind eyes, joint, muscle bone pain and bleeding
(nose, gums, bruising)
Dengue hemorrhagic fever is characterized by a fever that
lasts from 2 to 7 days
DENGUE ARE CLASSIFIED ACCORDING TO LEVELS OF
SEVERITY:
 Dengue without Warning Signs
 Dengue with Warning Signs
 Severe Dengue
There is no vaccine for preventing dengue. The best
preventive measure residents living in areas infested with Ae.
aegypti is to eliminate the places where the mosquito lays her
eggs, primarily artificial containers that hold water.
RABIES
 zoonotic disease and human infection caused by
Lyssavirus, after a transdermal bite or scratch by an
infected animal.
 Transmission may also occur when infectious
material, usually the saliva, comes into direct contact
with the victim’s mucosa or fresh skin lesions.
 It is a highly fatal disease characterized by
fluctuations in consciousness, phobic or inspiratory
spasms and auto- nomic instability.
Dogs are the source of the vast majority rabies deaths.
Bites from infected animals are the most common mode of
transmission of rabies to humans.
points of entry of the rabies virus and these may be in the
form of the following:
 Contamination of intact mucosa (eyes, nose, mouth,
genitalia) with saliva of infected animal;
 Licks on broken skin; and
 Inhalation of aerosolized virus in closed areas (e.g.
caves with rabid bats, laboratories for rabies
diagnosis).
Incubation period
 period from the time of exposure up to the
appearance of first clinical signs and symptoms of
rabies.
 The average incubation period of human rabies is
between one to three (I-3) months.
The duration of the incubation period depends on certain
factors:
 The amount of the virus inoculated into the wound
or mucosa.
 Severity of exposure - Patients with multiple and/or
deep penetrating bite wounds may have shorter
incubation period.
 Location of exposure -Patients with bite wounds in
highly innervated areas and/or close to the central
nervous system may have shorter incubation period.
After inoculation, the rabies virus multiplies in the muscle
cells (myocytes) may invade the nerve directly without prior
multiplication in the myocytes. It is possible
Prodromal stage
 occurs when there is initial viral replication at the
striated muscle cells at the site of inoculation just
before it enters the brain.
 This stage lasts for 0-10 days with non-specific
manifestations,
 fever, sore throat, anorexia, nausea, vomiting,
generalized body malaise, head-ache and abdominal
pain.
Paresthesia or pain at the site of bite
is due to viral multiplication at the spinal ganglion just before
it enters the brain.
Acute neurologic stage
 the stage when the virus reaches the CNS and
replicates most exclusively within the gray matter.
 This stage has two types of presentation:
encephalitic or furious type,
TREATMENT
post-exposure prophylaxis (PEP)
 When directly exposed to suspected rabid animal, it
is important that the person must be able to receive
as soon as possible.
 Initiation of post-exposure prophylaxis should not be
delayed
RABIES IS A VACCINE-PREVENTABLE DISEASE.
A person exposed to a rabid animal can given active and
passive immunization.
Active Immunization
Animal ABTCs are required to use only the recommended
Intradermal (ID) regimen

Passive immunization
Rabies Immunoglobulin (RIG) is given in combination with
rabies vaccine to provide the immediate availability of
neutralizing antibodies the site of the exposure before it is
physiologically possible for the patient to begin

A skin test must be performed prior to ERIG administration

using a gauge 26 needle. For skin testing,