HUMAN AND MICROBIAL INTERACTION

M icrobiology
BSN Semester: I
Unit:10
IFTIKHAR UL HAQ
DEMONSTRATOR
INS-KMU, PESHAWAR
 Unit Objectives
Define normal flora of the body

Enlist at least three beneficial role of normal flora

Differentiate between resident and transient normal flora

Discuss nosocomial infections

Demonstrate preventive measures to control nosocomial infections in patients

Counsel the patient properly to prevent the nosocomial infections

 Normal Flora

• The microbial population that inhabit at the internal and external surface of healthy, normal
humans and animals.

• Normal flora are also called COMMENSALS (i.e. organisms that dine together) or
MICROFLORA.

• Under normal conditions in a healthy human they are harmless and may even be beneficial.
 Origin of Normal Flora

• A fetus, is sterile when born, then new born start having the normal flora when passing
through mother’s vaginal tract and then to environment (air, food, etc.).

• With in few hours, oral and nasopharyngeal flora of neonate establishes.

• With in one day, resident flora of lower intestinal tract establishes.

• Our internal organs are sterile like the spleen, liver, pancreas, bladder, CSF, and blood
unless during infection.

• Normal flora differ from one human to another depending on age, diet, and geographic
habitat.
 Factors Influencing the Normal Flora

• Local environment

• Diet

• Age

• Sex

• Immune conditions

• Use of antibiotics
 Types of Normal Flora

 RESIDENT FLORA

• Microbes that are always present

• Consists of relatively fixed types of microorganisms regularly found in a given area at a

given age. If disturbed, it re-establishes itself.

• When the number of resident flora is greatly reduced, opportunistic microbes can easily
cause infections in the area.

e.g. Candida albicans that cause candidiasis

 Types of Normal Flora

 TRANSIENT FLORA

• Microbes that live in or on your body for a period of time then move on or die off.

• These are either pathogenic or non-pathogenic.

• Transient flora inhabits the skin or mucus membrane for hours (or) days (or) weeks.

• It varies from time-to-time/environment.

• Does not re-establishes by itself.

 The Importance of Normal Flora

1. Synthesizes B-complex and Vitamin-K.

2. They protect our body by preventing the colonization of pathogenic microorganisms.

3. It elevates the immune system.

4. Produces the anti-biotic like substance, e.g. fatty acids, peroxidases, bacteriocins, which
inhabits the growth of pathogenic microorganisms.

5. Some produce endotoxins which activates the complement pathway, it augment the
defense mechanism of the body.
 Harmful Effects of Normal Flora

1. When host immune system decreases they become opportunistic pathogens and cause
diseases.

2. Some may cause diagnose confusion.

3. Some penicillinase producing microorganisms can aggregate and develop antibiotic

resistance (Drug resistant).
 Distribution and Occurrence of the Normal Flora

• Normal flora of the skin

• Normal flora of the eye (or) conjunctiva

• Normal flora of the digestive tract

• Normal flora of the respiratory tract

• Normal flora of the urinary tract

• Normal flora of the genital tract

 Normal Flora of the Eye (or) Conjunctiva
• Low numbers present due to:

• High moisture

• Blinking of the eye mechanically removes the bacteria

• Lachrymal secretions include lysozyme

• The conjunctiva of the eye has primarily S.epidermidis, S.aureus, C.diphtheroid and
S.pneumoniae.

• Some skin normal flora are also present but at fewer amounts e.g. Corynebacterium
xerosis, Moraxella species, non-haemolytic streptococci, and Staphylococci.
 Normal Flora of the Skin
• The resident microflora of the skin consist primarily bacteria and fungi.

• Resident bacteria of the skin can be in any layer of the skin.

• Skin can acquire any transient bacteria from the environment but it either get washed off or
die because the skin is dry, has acidic pH and produce sweat and oil.
 Normal Flora of the Skin

Resident Flora Transient Flora

Staphylococcus-epidermis Micro coccus
Staphylococcus aureus Bacteroids
Streptococcus
Diptheroids
Propionibacterium acne
Yeast-candida
Normal Microbiota of the Skin
 Normal Flora of Digestive System

 MICROFLORA OF ORAL CAVITY

• They have both aerobic and anaerobic bacteria.

• The most common ones are : C.diptheroides, S.aureus, and S.epidermis.

• Also, yeast, moulds, protozoa and viruses can be living in mouth.

 MOUTH/ORAL CAVITY: Lactobacilli, Staphylococcus, Streptococci, Bacteroides,

Corynebacterium, Nocardia, etc.

 TEETH: Streptococcus mutants, haemolytic streptococci, fusobacterium, etc.

 Normal Flora of Gastro Intestinal Tract
 STOMACH: e.g.: acid tolerant streptococci, staphylococci lactobacilli, candida albicans, and
helicobacter.

 INTESTINE:

• SMALL INTESTINE:

 Duodenum: Gram +ve cocci and rods are more.

 Jejunum: Gram positive, gram negative bacterium can be seen, Lactobacilli diptheroids,
enterococcus faecalis, yeast-candida, albicans.

 Ileum: pH-alkaline, anaerobic gram +ve bacteria are more mainly entero bacterial, shigellosis,
typhoid.
 Normal Flora of Gastro Intestinal Tract
 LARGE INTESTINE:

• Largest microorganisms in the body.

Anaerobic gram positive, non-sporing
bacteria.

• bacteroids, bifidobacteria, lactobacillus,

E.coli, protease, yeast, candida and
protozoans, entamoeba hystolitica,
trichmonas.
 Normal Flora of Respiratory Tract

 Upper Respiratory Tract: Nasal passage, Pharynx, Esophagus

• The organisms which are involved are staphylococcus, streptococcus, diphtheroid,

bacteroides, micrococci, and haemophilus etc.

 Lower Respiratory Tract: Trachea, Bronchi, Lungs

• It is mostly sterile. Because the mucous membrane of the lungs remove any
microbes.
 Normal Flora of the Genitourinary Tract

 Normal Flora of Urinary Tract:

• Urethra and urinary bladder are sterile.

• Non-pathogenic gram positive cocci and gram negative enterobacteriaceae members

may be extremely found as normal flora.

 Normal Flora of Genital Tract:

• Mycobacterium smegmatis is a commonly present in both male and female genital

tract.
 Normal Flora of the Genitourinary Tract
 Male Genital Tract:

• Lactobacillus, Bacteroides, Staphylococci and Corynebacterium.

 Female Genital Tract:

• The vagina of new born is colonized by lactobacilli.

• The adult female genital tract has complex normal flora from puberty to menopause.

• The pH is acidic 4.2-4.6, acidophilic colonizing bacteria e.g. Lactobacilli known as

doderlines bacilli, staphylococcus epidermis, streptococci, peptostreptococci, clostridium
species, diphtheroid, candida.
 Tetanus
• Tetanus is an acute, often fatal, disease caused by an exotoxin produced by
the bacterium Clostridium tetani.

• It is characterized by generalized rigidity and convulsive spasms of

skeletal muscles.

• The muscle stiffness usually begins in the jaw (lockjaw) and neck and then
becomes generalized.

• First produced in animals in 1884

• Organism isolated in 1889

• Tetanus toxoid developed in 1924 and widely used during World War II.
 Tetanus

Incubation Period: 4 to 21 days

Reservoir : Domestic animals particularly horse dung and contaminated soil. (The spores are widely

distributed in soil and in the intestines and feces of horses, sheep, cattle, dogs, cats, rats, guinea pigs, and chickens. Manure-treated soil may contain large numbers of spores. In
agricultural areas, a significant number of human adults may harbor the organism. The spores can also be found on skin surfaces and in contaminated heroin.)

Rout of Entry: Wound

Mode of transmission : by contact of Spore with wound

Occurrence: Worldwide

Prevention & Control: Active immunization, public education

 Tetanus

Treatment:

Antitoxin

TIG ( TETANUS IMMUNOGLOBULINE)

Debridement of wound

Benzyl penicillin 600 mg 6 hourly I/V

Diazepam
Tetanus
 Tuberculosis

• Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis.

(Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The
bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads
through the air when a person with TB of the lungs or throat coughs, sneezes, or talks)

• Types:

1. Pulmonary TB - typically affects the lungs

2. Extra-pulmonary TB - can affect other sites

 Source Of Infection

• Most common source of infection is a case of tuberculosis whose sputum is positive for
Mycobacterium tuberculosis, who has received no treatment or incomplete/irregular
treatment.

• Other sources of infection are excreta of such patient, milk obtained from cows suffering
from TB and material from slaughtered tuberculosis animal.
 Mode Of Transmission

• Tuberculosis is a droplet (Air born)

infection; when people with lung TB
cough, sneeze or spit, they propel the TB
germs into the air.
 Mode Of Transmission

• Nose and throat (by inhalation) are commonest

point of entry.

• Mouth (by ingestion) is another point of entry for

Mycobacterium tuberculosis.

• Incubation Period: 4—12 weeks

• Occurrence: Pandemic
CLINICAL MANIFESTATIONS OF T.B
 Prevention & Control:

• Vaccination— BCG (Bacillus Calmette

Guerine)

• Public education, adequate diagnostic and

curative facilities, Isolation, concurrent and
terminal disinfection, Environmental
sanitation.
 Drug-resistant TB

Drug-resistant TB is caused by:

i. inconsistent or partial treatment, when patients do not

take all their medicines regularly for the required
period because they start to feel better,

ii. doctors and health workers prescribe the wrong

treatment regimens, or

iii. the drug supply is unreliable.

 Multidrug-resistant TB (MDR-TB)

• Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not

respond to, at least, Isoniazid and Rifampicin, the two most powerful, first-line (or
standard) anti-TB drugs.

• The primary cause of MDR-TB is inappropriate treatment.

• MDR-TB is treatable and curable by using second-line drugs.

 Multidrug-resistant TB (MDR-TB)

• However second-line treatment options are limited and recommended medicines are not
always available.

• The extensive chemotherapy required (up to two years of treatment) is more costly and can
produce severe adverse drug reactions in patients.

• In some cases more severe drug resistance can develop.

 Extensively drug -resistant TB (MDR-TB)

• Extensively drug-resistant TB (XDR-TB), is a form of multi-drug resistant tuberculosis

that responds to even fewer available medicines, including the most effective second-line
anti-TB drugs.

• About 450, 000 people developed MDR-TB in the world in 2012.

• It is estimated that about 9.6% of MDR-TB cases had XDR-TB.

 Prevention and control

1. Chemotherapy of cases

2. Chemoprophylaxis for contacts

3. Immunization of infants with BCG

4. Educate patients with TB about the mode of

disease transmission and how to dispose their
sputum and cover their mouth while coughing,
sneezing, etc.
 Prevention and control

Public health education about the modes of disease transmission and methods of control:

• ƒImproved standard of living

• ƒAdequate nutrition

• ƒHealth housing

• ƒEnvironmental sanitation

• ƒPersonal hygiene; etc.

• ƒActive case finding and treatment

 Nursing Considerations

1. Educate the patient how and when to take the prescribed medication.

2. Tell the patient not to stop the medication unless he/she is told to do so.

3. Tell the patient to come to the health institution if he/she develops drug side effects.

4. Advice the patient on the importance of taking adequate and balanced diet and to eat what
is available at home.

5. Involve the family in teaching on medication.

6. Tell the patient that Rifampicin colors the urine orange.

 Typhoid Fever

• A systemic bacterial infectious disease characterized by high

continuous fever, malaise and involvement of lymphoid.

• Causative Organism: Salmonella Typhi

• Other important members of salmonella include S. paratyphi A

& B. They cause enteric fever.

• Source & reservoir: Man is the only known reservoir of

infection - cases or carriers.
 Typhoid Fever

Incubation period : 1-3 weeks

Period of communicability: A case is infectious as long as the bacilli appear in stool or

urine.

Occurrence: pandemic (Worldwide)

Salmonellae are: gram -ve rods, facultatively aerobic.

 Predisposing Factors

• Age group - At any age but mainly in children and young adults.

• Occupation - working environment

• Socio-economic factors - inadequate sanitation facilities and unsafe water supplies.

• Nutritional status - mal-nutrition

 Predisposing Factors

• Carriers may be temporary or chronic.

• Temporary (convalescent or incubatory) carriers usually excrete bacilli up to 6-8 weeks. 5

% patients may become carriers. After one year, 3-4 per cent of cases continue to excrete
typhoid bacilli which are then called chronic carriers.
 Clinical manifestations
• First week: Fever, headache, myalgia,
relative bradycardia, constipation,
Leucopoenia—White cell count is less
than 4000/mm
• ƒSecond week: Rose spots on chest and
trunk, splenomegaly, abdominal distention
and tenderness, diarrhea.
 Diagnosis and Treatment

 Clinical presentation:

• ƒWidal test (but not as much reliable)

• Typhidot (IgM—recent infection , IgG—remote infection)

• Blood culture

 Treatment:

• ciprofloxacin 500 mg B.D or ceftriaxone for 14 days.

• Chronic carriers should be treated for 4 weeks

 Prevention and Control

 MEASURES DIRECTED TO RESERVOIR:

a) Case detection and treatment

b) Isolation from handling food etc.

c) Education on hand washing

d) Disinfection of stools and urine

e) Detection & treatment of carriers

 Prevention and Control

 MEASURES AT ROUTES OF TRANSMISSION:

a) Water & Food sanitation

b) Excreta disposal

c) Fly control

 MEASURES FOR SUSCEPTIBLES:

a) Immunization - TAB vaccine

b) Health education
 Cholera

• Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated

with the bacterium Vibrio cholerae. Cholera remains a global threat to public health and an
indicator of inequity and lack of social development.

• Definition: A severe acute gastrointestinal infection which is characterized by rice watery

stool.

• 10-20% of cholera patients develop severe watery diarrhea with vomiting.

• Outbreaks can occur where water supply, sanitation, food safety and hygiene are
inadequate.
 Cholera

• Greater risks occur in over-populated communities and refugee camps, with Poor
sanitation, Unsafe drinking water, Increased person to-person transmission.

• Because incubation period is very short, the number of cases can rise extremely rapidly.

• Treatment is straight forward (basically rehydration), and if applied correctly and promptly,
case fatality rate is <1%.

• In untreated cases, case fatality rate may reach 30-50%.

 Transmission of Cholera

• Transmitted by the fecal-oral route.

• Contaminated food (especially seafood) is a more common cause of cholera in developed

countries, whereas contaminated water is more common in developing countries.

• 88% of all diarrheal disease in the world can be attributed to unsafe water, sanitation and
hygiene.
 Cholera
• Sign/Symptoms: Fever, vomiting, rice watery stool, malaise, dehydration

• Causative organism: Vibrio cholerae: A comma shaped Gram –ve bacillus

• Incubation Period: Hours to 5 days

• Source and reservoir of Infection: Faeces and vomitus of infected and carrier person

• Rout of Entry: Oro-faecal

• Mode of transmission: Ingestion of contaminated food, water & 5 Fs (fluids, fingers,

flies, foods, and fields).
 Cholera

• Occurrence: Endemic in Asian countries where sanitation is poor.

• Prevention & Control:

• Active immunization, pure food and water supply, sanitary disposal of human excreta, fly
control, public education.

 Management: Fluid and electrolyte replacement, Tetracycline cotrimaxazole.

 Prevention and Control

• Food Protection & Safe Food in social gatherings and in market places.

 Key Messages:

Cook foods thoroughly

Store foods carefully

Reheat foods thoroughly

Avoid contacts between raw and cooked foods

Wash hands repeatedly during food preparation

 Safe Water
• Protection of water sources

• Treatment of water sources:

• Chlorination, filtration

• Safe Water collection and storage practices:

• Narrow-mouthed vessels

• Chlorination

• Household Water Treatment

 Boiling

 Chlorination
 DIPHTHERIA
 Definition: An acute bacterial infection of the upper respiratory tract (throat, nose & larynx)
characterized by the formation of grayish membrane in throat.

• Sign/Symptoms: Inflammation of throat, pseudo-membrane, dry cough

• Causative organism: Corynebacterium diphtheria or Klebs Loeffler bacillus. It is Gram +ve

bacillus. It releases exotoxin.

• Incubation Period: 2 to 5 days

• Reservoir & Source : Reservoir is infected man and source is nasopharyngeal secretion.
 DIPHTHERIA

• Rout of Entry: Inhalation

• Mode of transmission: by contact with patient or carrier and infected fomites.

• Occurrence: Worldwide

• Prevention & Control: Active immunization, Isolation, concurrent and terminal

disinfection of infected fomites

Treatment: Benzyl penicillin 600 mg 6 hourly I/V for 7 days.

 PERTUSSIS (WHOOPING COUGH)

 Pertussis History:

 The earliest clear account of whooping cough was described in 1640 by Baillow, an
epidemiologist.

 The name ‘pertussis’ means “violent cough”, and was first used to describe the disease in
1679.

 In China, the disease is known as “Hundred Day Cough”

 INTRODUCTION

• A highly contagious acute bacterial infection caused by the bacilli Bordetella pertussis

• Currently worldwide prevalence is diminished due to active immunization. However it

remains a public health problem among older children and adults.

• It continues to be an important respiratory disease afflicting unvaccinated infants and

previously vaccinated children and adults (waning immunity).
 Definition

• An acute bacterial infection of respiratory tract involving trachea, bronchi and bronchioles,
characterized by a typical cough.

• Sign/Symptoms: Crowing like Whooping sound cough, paroxysmal cough, tenacious

mucous, vomiting, catarrhal S/S.

• Causative organism: Bordetella Pertussis. It is Gram –ve bacillus.

Incubation Period: 7 to 21 days.

Reservoir & Source : Reservoir is infected man and source is brancho-pharyngeal secretion.

through infected fomites.

 Definition

• Rout of Entry: Inhalation

• Mode of transmission: By droplet through direct contact with infected patient and indirect
through infected fomites.

• Occurrence: Worldwide. Children below five years are more susceptible.

• Prevention & Control: Active immunization, Isolation, concurrent and terminal

disinfection of infected fomites

 Treatment: Erythromycin 250 mg 6 hourly. Antitussive drugs.

 TREATMENT

1. Avoidance of irritants, smoke, noise and other cough promoting factors.

2. Antibiotics: Effective only if started early in the course of illness. Erythromycin (40-
50 mg/kg/day 6 hourly orally for 2 weeks or Azithromycin 10 mg/kg for 5 days in
children <6 months and for children >6 months 10 mg/kg on day 1, followed by 5mg/kg
from day 2-5 or Clarithromycin 15 mg/kg 12 hourly for 7 days.

3. Supplemental oxygen, hydration, cough mixtures and bronchodilators (in individual

cases).
 PREVENTION

• All household contacts should be given erythromycin for 2 weeks.

• Children <7 years of age not completed the four primary dose should complete the same at
the earliest.

• Children <7 years of age completed primary vaccination but not received the booster in the
last 3 years have to be given a single booster dose.

• VACCINE
 MUMPS

 Definition: An acute viral infection primarily of salivary glands characterized by fever and
swelling of usually parotid glands.

• Signs/Symptoms: Malaise, anorexia, fever, sore throat, parotitis and swelling, tenderness at
angle jaw.

• Causative organism: Mumps Virus

• Incubation Period: 12 to 26 days

• Reservoir and Source of Infection: Infected person and source is infected saliva.
 MUMPS

• Rout of Entry: Respiratory tract

• Mode of transmission: direct through droplet and indirect via infected fomites.

• Occurrence: World wide especially younger people are more affected

• Prevention & Control: Active immunization - MMR (Measles, Mumps, Rubella) vaccine

pure food and water supply, public education.

 MEASLES (Rubeola)
 Definition: An acute highly communicable viral disease characterized by abrupt onset
catarrhal signs symptoms followed by fever.

• Sign/Symptoms: Catarrhal signs symptoms (running nose, lacrimation), fever, cough,

photophobia, Koplics spot , and On day 3-4 maculo-papular rashes.

• Causative organism: Measles virus

• Incubation Period: 10 to 14 days

• Reservoir & Source : Infected person and droplets

 MEASLES (Rubeola)
• Rout of Entry: Respiratory tract

• Mode of transmission: By direct contact with infected person and indirect through infected
fomites.

• Occurrence: World wide and Common in children

• Complications: stomatitis, keratitis, Enteritis, pneumonia, otitis media,

• Prevention & Control:

Active immunization - MMR vaccine.

Isolation, concurrent and terminal disinfection of infected fomites

 INFLUENZA (Flu)

 Definition: An acute highly communicable viral disease of respiratory tract.

• Sign/Symptoms: chills, fever, headache, and general muscular aches

• Causative organism: Influenza virus (RNA virus)

• Incubation Period: 24 to 72 hours

• Reservoir & Source : Reservoir is infected man and source is noso-pharyngeal secretion.

• Rout of Entry: Respiratory tract

 INFLUENZA (Flu)

• Mode of transmission: By droplet through direct contact with infected person and indirect
through infected fomites.

• Occurrence: Worldwide. Children younger are more common

• Prevention & Control: Active immunization, Isolation, concurrent and terminal

disinfection of infected fomites.
 POLIOMYELITIS

 Definition: An acute viral disease involving the nerve cells of spinal cord and brain stem.

• Sign/Symptoms: Fever, headache, stiffness of neck and spine, weakness and flaccid
paralysis.

• Causative organism: Polio virus

• Incubation Period: 7—21 days

• Source: Oro-pharyngeal secretion and faeces of infected person.

• Rout of Entry: Oro-faecal

 POLIOMYELITIS

• Mode of transmission : By contact with oro-pharyngeal secretion or faeces of infected

person. It reaches nervous tissues via lymphatic tissues and blood.

• Occurrence: Worldwide. Children from 1—12 years are common victims

• Prevention & Control: Active immunization, Isolation, public education

 Ascariasis

• Infectious Agent: Ascariasis is caused by the soil transmitted helminths Ascaris

lumbricoides and Ascaris suum. Both are roundworm intestinal nematodes. Ascaris
lumbricoides is found in humans and dogs, while Ascaris suum is most commonly found in
pigs, but can infect humans via consumption of contaminated meat.

• Occurrence: Ascaris lumbricoides is the most prevalent of all human intestinal nematodes
worldwide

• Causative agent: Ascaris lumbricoides

 Ascariasis

• Prevalence: Over 1 billion people infected worldwide (most prevalent of all intestinal
nematodes).

• Transmission: Transmission is primarily via ingestion of fecal contaminated soil. Eggs are
shed in an infected person’s feces but do not become infectious until they have incubated in
soil for 2-3 weeks. Once they become infectious they can be transmitted via contaminated
water, agriculture products, fingers, or other fomites.
 Ascariasis

• Incubation Period: Eggs must incubate in soil for 2-3 weeks before they become
infectious to humans. Once ingested it takes approximately 8 weeks for the eggs to develop
into an egg-laying adult female worm although symptoms may manifest earlier.

• Communicability: Human to human transmission of Ascaris spp. does NOT occur because
part of the worm’s life cycle must be completed in soil before becoming infectious. Soil
contamination is perpetuated by fecal contamination from infected humans or dogs for
Ascaris lumbricoides and humans (rarely) or pigs for Ascaris suum. An infected person may
shed eggs for as long as they are infected with an egg-laying adult which may be several
years.
 Life Cycle
1. Soil
2. Mouth
3. Intestines/bloodstream
4. Lungs
5. Throat
6. Intestines (with possible migration)
 Life Cycle

• Time period from ingestion of eggs to mature egg laying adults is approx. 8 weeks. Adult
worms can live in the intestines for up to 2 years.

• Infected individuals have an output of up to 200,000 eggs a day.

1. Fertilized infective Ascaris spp. eggs from contaminated soil are ingested.

2. Migrate into the bloodstream and eventually the lungs.

3. Larvae mature in the lungs and then ascend the bronchial tree and are swallowed.

4. Once in the small intestine the larvae develop into a mature adult worm.
 Life Cycle

• Adult worms live in the lumen of the small intestine. A female may produce approximately 200,000
eggs per day, which are passed with the feces . Unfertilized eggs may be ingested but are not
infective. Fertile eggs embryonate and become infective after 18 days to several weeks , depending
on the environmental conditions (optimum: moist, warm, shaded soil). After infective eggs are
swallowed , the larvae hatch , invade the intestinal mucosa, and are carried via the portal, then
systemic circulation to the lungs . The larvae mature further in the lungs (10 to 14 days), penetrate
the alveolar walls, ascend the bronchial tree to the throat, and are swallowed . Upon reaching the
small intestine, they develop into adult worms . Between 2 and 3 months are required from
ingestion of the infective eggs to oviposition by the adult female. Adult worms can live 1 to 2 years.
 Signs & Symptoms

• 85% of cases are asymptomatic

• Fever during migratory phase

• Intestinal obstruction due to a bolus of worms

• Inflammation of internal organs including pancreatitis and appendicitis

• In mild or moderate ascariasis, the intestinal infestation can cause: Vague abdominal pain,
Nausea and vomiting, Diarrhea or bloody stools.
 Signs & Symptoms

• If you have a large number of worms in the intestine, you might have:

• Severe abdominal pain.

• Fatigue.

• Vomiting.

• Weight loss or malnutrition.

• A worm in your vomit or stool.

 Diagnosis and Treatment

• Laboratory Criteria: Microscopic identification of Ascaris eggs in feces OR

• Microscopic identification of ascrid larvae in sputum or gastric washings OR

• Identification of adult worms passed from the anus, mouth or nose.

• Anthelminthic such as albendazole and mebendazole, are the drugs of choice for treatment
of Ascaris infections

• Infections are generally treated for 1-3 days.

 Prevention and Control Measures

• Routine hand washing with soap and warm water.

• Proper disposal of human waste products such as feces is necessary to prevent

contamination of soil.

• Avoid areas where human waste contamination of soil or water is likely.

• Proper removal and disposal of pet waste from outdoor areas

• Thoroughly wash fruits and vegetables to remove soil/fertilizer residue.

 Prevention and Control Measures

• Thoroughly cook all fruits and vegetables that may have been in contact with soil produced
from human and animal waste.

• Cook all pork products to the appropriate temperature prior to consumption and wash hands
thoroughly before and after handling raw meat.
 Taeniasis

• Taeniasis is an infection caused by the tapeworm, a type of parasite. Parasites are small
organisms that attach themselves to other living things in order to survive. The living things
the parasites attach to are called hosts.

• Parasites can be found in contaminated food and water. If you consume contaminated food
or drinks, you may contract a parasite that can live and sometimes grow and reproduce
inside your body.
 Taeniasis

• Taeniasis is an intestinal tapeworm infection caused by eating

contaminated beef or pork. It’s also known by the following names:
• Taenia saginata (beef tapeworm)

• Taenia solium (pork tapeworm)

 Symptoms of Taeniasis

• Most people who have taeniasis don’t have any symptoms. If signs and symptoms are
present, they may include:

• pain

• unexplained weight loss

• blockage of the intestine

• digestive problems
 Symptoms of Taeniasis

• Some people with taeniasis may also experience irritation in the perianal area, which is the
area around the anus. Worm segments or eggs being expelled in the stool cause this
irritation.

• People often become aware that they have a tapeworm when they see worm segments or
eggs in their stool.

• Infections can take between 8 and 14 weeks to develop.

 Causes of Taeniasis

• You can develop taeniasis by eating raw or undercooked beef or pork. Contaminated food
can contain tapeworm eggs or larvae that grow in your intestines when eaten.

• Fully cooking beef or pork will destroy the larvae so that they can’t live in your body.

• The tapeworm can grow up to 12 feet in length. It can live in the intestines for years
without being discovered. Tapeworms have segments along their bodies. Each of these
segments can produce eggs. As the tapeworm matures, these eggs will be passed out of the
body in the stool.
 Causes of Taeniasis

• Poor hygiene can also cause the spread of taeniasis. Once tapeworm larvae are in human
stool, they can be spread through contact with the stool. You should wash your hands
properly to help prevent the spread of the infection.
 Risk factors for Taeniasis

• Taeniasis is more commonTrusted Source in areas where raw beef or pork is consumed and
where sanitation is poor. These areas may include:

• Eastern Europe and Russia

• East Africa

• sub-Saharan Africa

• Latin America

• parts of Asia, including China, Indonesia, and South Korea.

 Risk factors for Taeniasis

• According to the Centers for Disease Control and Prevention (CDC)Trusted Source, there
are probably fewer than 1,000 new cases in the United States each year. However, people
who travel to areas where taeniasis is more common are at risk of contracting the disease.

• Taeniasis is more likely to develop in people who have weakened immune systems and
aren’t able to fight off infections. Your immune system can weaken due to:

• HIV, AIDS, an organ transplant, diabetes, and chemotherapy.

 Diagnosis

• See your doctor if you see worm segments or eggs in your stool. Your doctor will ask you
about your health history and recent travel outside of the United States. Doctors will often
be able to make a diagnosis of taeniasis based on the symptoms.

• To confirm the diagnosis, your doctor may order blood tests including a complete blood
count (CBC). They may also order a stool exam to see if eggs or worm segments are
present.
 Treatment

• Taeniasis is typically treated with medications prescribed by your doctor. Medications for
the treatment of taeniasis include praziquantel (Biltricide) and albendazole (Albenza).

• Both drugs are antihelmintics, which means that they kill parasitic worms and their eggs. In
most cases, these medications are provided in a single dose. They can take a few weeks to
fully clear an infection. The tapeworm will be excreted as waste.

• Common side effects associated with these medications include dizziness and upset
stomach.
 Complications

• In rare cases, serious complications from the infection can occur. Tapeworms may block
your intestines. This may require surgery to correct.

• In other cases, a pork tapeworm may travel to other parts of your body such as the heart,
eye, or brain. This condition is called cysticercosis. Cysticercosis can cause other health
problems such as seizures or infections in the nervous system.
 Prevention

• The most effective way to prevent taeniasis is to cook food thoroughly. This means cooking
meat to a temperature above 140°F (60°F) for five minutes or more. Measure the meat
temperature with a cooking thermometer.

• After cooking meat, allow it to stand for three minutes before cutting it. This can help
destroy any parasites that may be in the meat.

• Proper hand hygiene is also important for preventing the spread of this disease. Always
wash your hands after using the bathroom and teach your children to do the same.

• Also, drink bottled water if you live in or travel to an area where water must be treated.
 DERMATOMYCOSES

• Ringworm- (Dermatophytosis, Tinea, Trichophytosis, Microsporosis, Jock Itch, Athlete's Foot)

• Ringworm — also known as dermatophytosis, dermatophyte infection, or tinea — is a fungal

infection of the skin.

• “Ringworm” is a misnomer, since a fungus, not a worm, causes the infection. The lesion
caused by this infection resembles a worm in the shape of a ring, which is why it got its name.

• Ringworm is usually specifically used to describe tinea corporis (ringworm of the body) or
tinea capitis (ringworm of the scalp). It’s sometimes used to describe tinea infection in other
locations, such as tinea cruris (ringworm of the groin).
 DERMATOMYCOSES

• Ringworm infection can affect both humans and animals. The infection initially appears as
discolored, often scaly patches on affected areas. These patches typically appear red on
lighter skin or brown-gray on darker skin.

• Ringworm may spread from an affected area to other parts of the body, such as the:

• Scalp, Feet, Hands, Nails, Groin, Beard

 Recognizing ringworm symptoms

• Symptoms vary depending on where the infection occurs. With a skin infection, you may
experience the following:

• itchiness

• itchy or scaly patches that are red, brown, or gray, or raised areas of skin called plaques

• a round, flat patch of itchy skin

• patches that develop blisters or pustules

 Recognizing ringworm symptoms

• patches that resemble a ring with deeper color on the outside

• patches with edges that are defined and raised

• overlapping rings

• hair loss

• Ringworm can look different depending on which part of the body is affected. Doctors call
ringworm different names depending on where it appears on the body.
 Recognizing ringworm symptoms

• Body

• The term “ringworm” is most commonly used to refer to tinea corporis, or ringworm of
the body. This form often appears as patches with the characteristic round ring shape on
your torso or limbs.
 Recognizing ringworm symptoms

• Scalp

• Ringworm of the scalp, or tinea capitis, often starts as isolated scaling in the scalp that
develops into itchy, scaly bald patches. It’s most common among children. Hair around the
affected area may break or fall off, and bald patches may develop.
 Recognizing ringworm symptoms

• Beard

• Ringworm of the beard, also called tinea barbae, affects your cheeks, chin, and upper neck
and can cause bald patches. This may look like acne, folliculitis, or another skin condition.
Some people experience fatigue or swollen lymph nodes.
 Recognizing ringworm symptoms

• Hands

• Ringworm of the hand, or tinea manuum, is usually caused by touching another affected
area, such as your groin or foot. Infection of the hand may look like very dry skin with deep
cracks on the palm.

• If the infection spreads, you may see ring-shaped patches on the back of your hand.
 Recognizing ringworm symptoms

• Groin

• Jock itch, known as tinea cruris, refers to ringworm infection of the skin around the groin,
inner thighs, and buttocks. It’s most common in men and adolescent boys.

• This usually starts as an itchy red, brown, or gray rash where your leg and body meet. The
itching may intensify after exercise and may not improve after using anti-itch cream.
 Recognizing ringworm symptoms
• Feet: Athlete’s foot, or tinea pedis, is the common name for ringworm infection of the foot.
It’s frequently seen in people who walk barefoot in public places where the infection can
spread, such as locker rooms, showers, and swimming pools.

• This starts as dry scaly skin between your toes that may spread to your sole and heel.
Symptoms may include:

• an itching, stinging, or burning sensation

• blistering

• peeling

• a foul odor
• Nails

• Onychomycosis, also called tinea unguium, is a ringworm infection of the nails. It affects
toenails more than fingernails, as footwear often provides a moist, warm environment that
fungi prefer.

• Affected nails may become thicker or discolored. They may even begin to crack or lift away
from your nail bed.
 Causes of ringworm

• About 40 different species of fungus can cause ringworm. They are typically of
the Trichophyton, Microsporum, and Epidermophyton types.

• These fungi can live on your skin and other surfaces, particularly damp areas. They may
also live for an extended period of time as spores in soil.
 The fungi can spread to humans in four ways:

• Human to human. You can get the infection if you come in contact with a person who has
ringworm or if you share personal items, such as combs or towels. The infection is
commonly spread among children and by sharing items harboring the fungus.

• Animal to human. You can get ringworm after touching an affected animal or even items
the animal has come in contact with. Cats and dogs are common sources, but other animals,
such as farm animals, can spread the fungi as well.
 The fungi can spread to humans in four ways:

• Object to human. You may get the infection if you come in contact with an object or
surface that has it, such as a telephone or the floor of a public shower. These fungi thrive in
damp environments.

• Soil to human. Humans and animals can get ringworm after direct contact with soil that is
carrying the fungi.
 Ringworm risk factors

Anyone can get ringworm, but you may be more at risk if you:

• live in a warm, humid environment or climate

• participate in contact sports, like wrestling or football

• use public showers or locker rooms

• come in close contact with animals

 Ringworm risk factors

• wear tight shoes or clothes that chafe your skin

• have diabetes

• have obesity or are overweight

• sweat excessively

• have a weakened immune system

 Getting a ringworm diagnosis

• Your doctor will diagnose ringworm by examining your skin and possibly using a black
light to view the affected area. Depending on the type of fungus, it may sometimes
fluoresce (glow) under black light.

• Your doctor may confirm a diagnosis of ringworm by requesting certain tests:

• If you’re getting either a skin biopsy or fungal culture, your doctor will take a sample of
your skin or discharge from a blister and send it to a lab to test for the presence of
fungus.
 Getting a ringworm diagnosis

• If you’re getting a KOH exam, your doctor will scrape off a small area of affected skin
onto a slide and place drops of a liquid called potassium hydroxide (KOH) on it. The
KOH breaks apart typical skin cells, making the fungal elements easier to see under a
microscope.
 Ringworm treatment

• Your doctor may recommend both medications and lifestyle adjustments to

treat ringworm.

 Medications: Your doctor may prescribe various medications depending on

the severity of your ringworm infection.
• Jock itch, athlete’s foot, and ringworm of the body can all typically be treated with
topical medications, such as antifungal: creams, ointments, gels, and sprays
 Ringworm treatment

• Some severe cases may be treated with oral medications.

• Ringworm of the scalp or nails may require prescription-strength oral

medications, such as griseofulvin (Gris-PEG) or terbinafine.

• Your doctor may recommend over-the-counter (OTC) medications and

antifungal skin creams as well. These products may contain clotrimazole,
miconazole, terbinafine, or other related ingredients.
 Lifestyle adjustments

• In addition to prescription and OTC medication, your doctor may recommend that you care
for the infection at home by:

• washing bedding and clothing daily to help disinfect your surroundings

• drying your skin thoroughly after bathing

• wearing loose clothing in affected areas

• treating all affected areas, as not treating tinea pedis can lead to the recurrence of tinea
cruris.