School Prerequistes

Mansoura University
Faculty of Nursing
Community Health Nursing Department
Community Health Nursing Course (Practical)
School Prerequisites
Prepared By:
Community Health Nursing Staff
2023-2024
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Content
Topic Page No.
Air-borne diseases
Measles 3
Mumps 6
German Measles (Rubella) 9
Chicken Box 13
Acute Rheumatic fever 17
Food-borne diseases
Typhoid fever 24
Hepatitis A 29
Parasitic diseases
Ascaris 33
Pinworm 37
Skin contact
Schistosomiasis 42
Chronic diseases
Iron Deficiency Anemia 50
Juvenile diabetes 58
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Measles
Definition
▪ Measles is a highly contagious, serious airborne disease caused by a virus that can lead to
severe complications and death.
▪ Causative agent: Measles is caused by infection with the rubeola virus, a paramyxovirus of
the genus Morbillivirus.
▪ Incubation period: Average is 10-12 days (the range is seven to 21 days).
▪ Communicability period: Communicability 4 days before through 4 days after rash onset
Mode of transmission & Risk Factors

Transmission
Measles transmission occurs person-to-person via large respiratory droplets and via airborne
transmission of aerosolized droplet nuclei in closed areas (e.g., an office examination room) for
up to 2 hours after a person with measles occupied the area.
Risk Factors
▪ Age: children aged <5 years, aged >20 years
▪ Season: during winter commonly
▪ Unvaccinated young children
▪ History of contact with droplets from the nose, mouth, or throat with infected person
▪ Environmental: Poor ventilation, over crowdedness
Clinical manifestation (Signs &Symptoms)

Pre- eruptive stage: the period before appearance of rash over the body of patient
▪ Fever, cough, runny nose, sore throat

▪ eye redness, Light sensitivity (photophobia)
▪ Muscle pain
▪ Tiny white spots inside the mouth (Koplik's spots)
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Eruptive stage:
Bright pink or red color rashes appear first at hairline then involve face and neck and then on
chest and all over body including upper and lower limbs. After 5 to 6 days rash begin to
disappear leaving brownish discoloration.
Physical examination and/ or Diagnostic measures

▪ Clinical manifestation
▪ Viral culture: a throat swab specimen for RT-PCR
▪ Measles serology: serum specimen for IgM detection
Management & Prevention

Prevention
Immunizations are the best way to prevent the spread of measles.
The MMR vaccine is 97% effective after two doses. Doctors recommend that children get the
first dose when they're between 12 and 15 months old, and the second between 4 and 6 years old.
Management
▪ There is no specific treatment for measles.
✓ Post-exposure vaccination. If never had a measles vaccination, get PE up to 72 hours
after being around the virus. The vaccine can lower chances of getting it and can make
symptoms milder if you do.
✓ Immune serum globulin. This protein injection can boost immune system if you’re
pregnant, very young, or have a condition that makes it weak. It can be given within 6 days
of exposure to the virus. The injection may either prevent measles or keep measles
symptoms from being severe.
▪ Medical care is supportive and helps relieve symptoms and address complications such as
bacterial infections.
▪ Isolation: Individuals with measles should be isolated for 4 days after developing a rash
▪ Fever: Antipyretic (paracetamol, acetaminophen) or ibuprofen are effective in controlling
fever, as well as aches and pain. Children under 16 should not be given aspirin.
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▪ Photophobia: keeping the lights dim or the room darkened may help. Sunglasses may also
help.
▪ Conjunctivitis: kept in a closed and darkened room, if there is crustiness around the eyes gently
clean with damp cotton wool.
▪ Cough: cough medicines will not relieve the cough. Making the room more humid by placing
a bowl of water may help the cough. If the child is over twelve a glass of warm water with a
teaspoon of lemon juice and two teaspoons of honey may help.
▪ Dehydration: make sure the child is hydrated. If the child has a fever he/she can become
dehydrated more quickly. Encourage the child to drink plenty of fluids, easily digested food
▪ Vitamin A supplements: help prevent complications caused by measles.
▪ Care of skin: Local skin moisturizers for itchy rash, bathing, oral hygiene should be given,
soap should be omitted during eruptive stage.
Complications
▪ Ear infections. This is a very common complication caused by bacteria, that can cause
permanent hearing loss.
▪ Bronchitis, laryngitis, or croup.
▪ Diarrhea.
▪ Pneumonia.
▪ Encephalitis, a brain infection that can cause deafness and brain damage.
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Mumps
Definition
▪ An acute infectious viral illness caused by paramyxovirus group. It is characterized most
commonly by enlargement and tenderness of one or both parotid gland.
▪ Causative agent: Mumps is caused by paramyxovirus group (mumps virus)
▪ Incubation period: Average 16 to 18 days with a range of 2 to 4 weeks.
▪ Communicability period: Mumps is communicable from 6-7 days before to 9 days after onset
of parotitis.
Risk Factors & Mode of transmission

Transmission
▪ Direct contact: Mumps spreads from person to person via droplets of saliva or mucus from the
mouth, nose, or throat of an infected person, usually when the person coughs, sneezes, or talks.
▪ Indirect contact: Using the same cutlery/plates with someone infected. Sharing food and drink
with someone infected
Risk Factors
▪ Age: More common in age group 5-15 years

▪ Non-immunized children with MMR
▪ Season: winter &spring seasons
▪ Overcrowding &poor ventilation environment

▪ Pain, tenderness, and swelling in one or both parotid salivary glands (cheek and jaw area).
Swelling usually peaks in 1 to 3 days and then subsides during the next week.
▪ Nonspecific prodromal symptoms
✓ Low-grade fever
✓ Malaise
✓ Headache
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✓ Muscle aches
✓ Loss of appetite
✓ Pain around ear & jaws
✓ Pain &stiffness on opening the mouth
1. Clinical manifestation (main diagnostic measures)

2. Blood test to look for antibodies to the mumps virus
3. RT-PCR and viral culture are used to confirm mumps infection.
4. Throat culture: Buccal swabs are most commonly used for RT-PCR testing

Prevention
Vaccination is the best way to prevent mumps and mumps complications. This vaccine is included
in the combination measles-mumps-rubella (MMR) and measles-mumps-rubella-varicella
(MMRV) vaccines. These are usually given between ages 12 and 15 months and again between
ages 4 and 6 years, or between 11 and 12 if not previously given.
Management
▪ Isolation& bed rest untill clinical manifestation subsides

▪ All articles should be disinfected
▪ Contacts should be under supervision
▪ Respiratory precautions are recommended until swelling subside
Because mumps is caused by a virus, antibiotics aren't effective. Fortunately, most children and
adults recover from an uncomplicated case of mumps within about two weeks.
Supportive care
▪ (Analgesic) Acetaminophen (Tylenol) to reduce fever and relieve general body discomfort
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▪ Warm or cold compresses to relieve pain and swelling in the parotid glands
▪ A soft diet to reduce the need for chewing — avoid fruit juices and tart beverages that
stimulate the salivary glands and make gland pain worse
▪ Plenty fluids
▪ Cool compresses and support for the scrotum to reduce pain and swelling in the testicles
Aspirin should not be used in children with mumps because of the risk of Reye’s syndrome, (a
serious brain problem that develops in children who have certain viral illnesses and have been
treated with aspirin).
Complications
▪ Inflammation of the testicles (orchitis) in males who have reached puberty; rarely does this
lead to fertility problems
▪ Inflammation of the brain (encephalitis)
▪ Inflammation of the tissue covering the brain and spinal cord (meningitis)
▪ Inflammation of the ovaries (oophoritis) and/or breasts (mastitis) in females who have
reached puberty
▪ Deafness
▪ Miscarriage. Although it isn't proved, contracting mumps while you're pregnant, especially
early on, may lead to miscarriage.
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German Measles
Definition
Rubella is a contagious disease caused by a virus. It is also called “German measles,” but it is
caused by a different virus than measles.
▪ Causative agent: German measles is caused by infection with the rubella virus
▪ Incubation period: Average is 17 days, (with a range of 12 to 23 days).
▪ Communicability period: Communicability 7 days before to 7 days after rash onset

Transmission
▪ Direct contact with patient &patient's infective material
▪ Droplets from a sneeze or cough& droplet nuclei.
▪ Indirect spread through Contact with contaminated clothing, bed linens, Oozing blisters of
an infected person.
Risk Factors
▪ Age: children aged 5-9 years, women of childbearing age
▪ Unvaccinated young children
▪ Woman is infected with rubella while she is pregnant, she can pass it to her developing baby
▪ History of contact with droplets from the nose, mouth, or throat with infected person

In children, rubella is usually mild, with few noticeable symptoms., a pink or light rash is
typically the first sign.
Prodromal stage (Pre-eruptive stage):
These symptoms occur 1 to 5 days before the rash appears.
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▪ A low-grade fever
▪ Headache
▪ Mild pink eye (redness or swelling of the white of the eye)
▪ General discomfort
▪ Swollen and enlarged lymph nodes usually in the back of the neck or behind the ears.
▪ Cough
▪ Runny nose
Eruptive stage:
The pink or light red rash generally first appears on the face and then spreads to the rest of the
body, and lasts about three days. The rash of German measles is scattered (not flow together as
measles). They leave some desquamation, but not discoloration of skin as measles
The virus also can pass through a pregnant woman's bloodstream to infect her unborn child.
Babies born with congenital rubella syndrome are at risk for serious problems with their
growth, thinking, heart and eyes, hearing, and liver, spleen, and bone marrow.

▪ Clinical manifestation: based on the red rash
▪ Viral culture: culture of lesion samples for RT-PCR
▪ Viral serology: serum specimen for IgM detection

Prevention
▪ Vaccination
Is a safe and effective way to prevent German measles. The rubella vaccine is typically combined
with vaccines for the measles and mumps.
These vaccines are usually given to children who are between 12 and 15 months old. A booster
shot will be needed again when children are between ages 4 and 6 yrs.
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▪ Pregnant mother
All pregnant women should be tested for immunity to rubella prior to, during early pregnancy.
Women of childbearing age should have their immunity to rubella tested before becoming
pregnant.
Management
There is no specific medicine to treat rubella or make the disease go away faster. In many cases,
symptoms are mild. For others, mild symptoms can be managed with bed rest and symptomatic
treatment.
medicines
▪ For fever, use acetaminophen, paracetamol or ibuprofen.
▪ Drink plenty of fluids: if child has a high temperature, they may be at risk of dehydration.
▪ For cold-like symptoms such as a runny nose, sore throat or a cough, there are steam inhalation
to relief from a cough, warm drinks, particularly ones containing lemon or honey, may also
help to relax their airways, loosen mucus and soothe a cough.
Complications
Rubella is a mild infection. Once person had the disease, he usually permanently immune.
Some women with rubella experience arthralgia in the fingers, wrists and knees, which
generally lasts for about one month.
In rare cases, rubella can cause an ear infection (otitis media) or inflammation of the brain
(encephalitis).
However, if you're pregnant when you contract rubella, the consequences for your unborn child
may be severe. Up to 90 percent of infants born to mothers who had rubella during the first 12
weeks of pregnancy develop congenital rubella syndrome. This syndrome can cause one or
more problems, including:
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• Growth retardation
• Cataracts
• Deafness
• Congenital heart defects
• Defects in other organs
• Mental retardation
The highest risk to the fetus is during the first trimester, but exposure later in pregnancy also is
dangerous.
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Chicken Box
Definition
Chickenpox is a highly contagious disease, a viral illness characterized by a very itchy red rash,
is one of the most common infectious diseases of childhood. Chickenpox can be serious,
especially during pregnancy, in babies, adolescents, adults, and people with weakened immune
systems.
▪ Causative agent: Is caused by the herpes varicella – zoster virus.
▪ Incubation period: Average is 14 to 16 days (usually rang 10 to 21)
▪ Communicability period: Communicability a day or two before the rash appears and until
the rash is completely dry and scabbed over, about five to six days after onset of the rash.
Mode of transmission & Risk Factors

Transmission
▪ Direct contact with patient &patient's infective material
▪ Droplets from a sneeze or cough& droplet nuclei.
▪ Indirect spread through Contact with contaminated clothing, bed linens, Oozing blisters of
an infected person.
Risk Factors
▪ Age: children aged below 10 years
▪ Pregnant Women. Who have not had chicken pox or been immunized for chicken pox
▪ Immunocompromised Persons.
▪ People with HIV or AIDS.
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Clinical manifestation (Signs & Symptoms)
Prodromal stage (Pre-eruptive stage):
• Fever
• Loss of appetite
• Headache
• Tiredness and a general feeling of being unwell (malaise)
• Cold, cough, running nose
These symptoms are marked in adult, but may be absent in children& more severe
Eruptive stage:
The first sign of chicken pox is appearance of eruption. The rashes consist of red maculopapular
spots which appear first on abdomen and soon spread all over body.
Once the chickenpox rash appears, it goes through three phases:
• Raised pink or red bumps (papules), which break out over several days
• Small fluid-filled blisters (vesicles), forming from the raised bumps over about one day
before breaking and leaking
• Crusts and (scabs), which cover the broken blisters and take several more days to heal.

▪ Clinical manifestation: based on the telltale rash
▪ Viral culture: culture of lesion samples for RT-PCR
▪ Viral serology: serum specimen for IgM detection
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Prevention & Management
Prevention
▪ Vaccination: The best way to prevent chickenpox is to get the chickenpox vaccine.
▪ Two doses are recommended.
▪ If child under 13 one dose between the ages of 12 and15 months, and the second between the
ages of four and six years.
▪ If be 13 or older and never got the vaccine, should get two doses at least 28 days apart.
Management
▪ There is no specific treatment for Chicken Pox. Symptomatic treatment helps to reduce
discomfort in patient.
▪ Antiviral drugs: to fight the virus, such as acyclovir (Zovirax, Sitavig). This medicine
may lessen the symptoms of chickenpox. But they work best when given within 24 hours
after the rash first appears.
▪ Complete bed rest.
▪ The treatment is based on antipyretic and sulphonamides to prevent secondary infection.
▪ For itchy rash:
✓ Application of soothening lotion on the skin as calamine lotion or cold creams
✓ A cool bath with added baking soda, aluminum acetate or uncooked oatmeal.
✓ Antihistamines such as diphenhydramine (Benadryl) for itching.
✓ Don’t scratch the itchy skin: Scratching the skin can cause scarring, slow healing and
raise the risk that the sores will get infected.
Complications
▪ Scarring: chickenpox can leave pockmark scars on the skin.
▪ Bacterial infections of the skin and soft tissues in children, including Group A streptococcal
infection
▪ Infection of the lungs (pneumonia)
▪ Infection or swelling of the brain (encephalitis, cerebellar ataxia)
▪ Bleeding problems (hemorrhagic complications)
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▪ Bloodstream infections (sepsis)
▪ Dehydration
▪ Death in rare cases.
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Acute Rheumatic Fever
Definition
▪ Rheumatic fever (acute rheumatic fever) is a condition that can affect the heart, joints, brain,
and skin. Rheumatic fever can develop if strep throat, scarlet fever, and strep skin infections
are not treated properly.
▪ Rheumatic fever is not contagious:
People cannot catch rheumatic fever from someone else because it is an immune response
and not an infection. However, people with a group A strep infection can spread the bacteria
to others.
▪ Causative agent:
Group A beta hemolytic streptococci (GAS).
Rheumatic fever may develop if strep throat infection (bacterial pharyngitis) or scarlet fever
and strep skin infections are not treated properly.
▪ It usually takes about 1 to 5 weeks after one of these infections for rheumatic fever to
develop.

▪ 1. Infectious illnesses, including group A strep infection,
▪ 2. Genetic factors: The chance of having RF appears to be higher if another family member
has had it.
▪ 3. Age: children aged 5 -15 years.
▪ 4. Season: during winter commonly.
▪ 5. Environmental factors: such as overcrowding, poor sanitation, and poor access to healthcare
increase the risk of developing infection.

Symptoms of rheumatic fever can include:
▪ Fever
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▪ Arthralgia
▪ Arthritis (painful, tender joints), most commonly in the knees, ankles, elbows, and wrists
▪ Fatigue (tiredness)
▪ Chorea (jerky, uncontrollable body movements)
▪ Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons.
They commonly appear on the back of the wrist, the outside elbow, and the front of the
knees.
▪ Erythema marginatum: A long-lasting reddish rash that begins on the trunk or arms as
macules, which spread outward and clear in the middle to form rings, which continue to
spread and coalesce with other rings, ultimately taking on a snake-like appearance. This rash
typically spares the face and is made worse with heat.
Symptoms of congestive heart failure, including
▪ chest pain, shortness of breath, fast heartbeat
In addition, someone with rheumatic fever can have:
A new heart murmur
An enlarged heart
Fluid around the heart

1. Clinical manifestations:
Based on Jones’ criteria: The major diagnostic criteria are carditis, arthritis, chorea, erythema
marginatum, and subcutaneous nodules, whereas the minor criteria are arthralgia, hyperpyrexia,
high erythrocyte sedimentation rate (ESR), and/or high C-reactive protein (CRP), and prolonged
PR interval.
▪ ((According to revised Jones criteria, the diagnosis of rheumatic fever can be made when
two of the major criteria, or one major criterion plus two minor criteria, are present along
with evidence of streptococcal infection))
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2. Lab investigation
▪ Throat culture
Throat culture remains the criterion standard for confirmation of group A streptococcal
infection.
▪ Antibody titer tests
Antibody titer tests used include ASO test, antistreptococcal DNAse B (ADB) test, and the
antistreptococcal hyaluronidase (AH) test.
ASO is a test used to detect streptococcal antibodies directed against streptococcal lysin O. An
elevated titer is proof of a previous streptococcal infection. It is usually more elevated after a
pharyngeal than skin infection, while the ADB is typically elevated regardless of the site of the
infection.
Acute and convalescent sera, if available, are helpful for proving recent streptococcal infection.
The antibody tests must be interpreted with caution in areas with high rates of streptococcal
infection and ARF, as relatively high titers are commonly encountered in the population. These
tests are of greater utility in areas with lower prevalence (eg, in most Western countries).
▪ Acute-phase reactants, erythrocyte sedimentation rate, and C-reactive protein
Acute-phase reactants, the erythrocyte sedimentation rate (ESR), and C-reactive protein levels
(CRP) are usually elevated at the onset of ARF and serve as a minor manifestation in the Jones
criteria. These tests are nonspecific, but they may be useful in monitoring disease activity.
▪ Blood cultures
Blood cultures are obtained to help rule out infective endocarditis, bacteremia, and disseminated
gonococcal infection.
3. Imaging Studies
▪ Electrocardiogram (EKG) an electrical tracing of the heart to detect abnormal heart rhythms
suggesting inflammation.
▪ Echocardiography, an ultrasound of the heart to look for inflammation or heart valve
damage. showing features of heart block, such as a prolonged PR interval.
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Prevention & Management
Prevention
The most effective way to make sure that child doesn’t develop rheumatic fever is to treat their
strep throat infection quickly and thoroughly. This means making sure child completes all
prescribed doses of medication (treatment within 10 days with an appropriate antibiotic). In
addition, schedule a follow-up visit to ensure that your child is free from strep bacteria
antibodies.
Practicing proper hygiene methods can help prevent strep throat. These include
▪ Covering your mouth when coughing or sneezing

▪ Washing your hands
▪ Avoiding contact with people who are sick
▪ Avoiding sharing personal items with people who are sick
Management (Control measures)

The main aims of management are to:
▪ Eradicate the streptococcal infection if infection is still present (usually a pharyngitis).
▪ Suppress inflammation arising from the autoimmune response.
▪ Provide supportive treatment, particularly for cardiac complications such as congestive
cardiac failure.
General
1. Bed rest
2. Antibiotics: as penicillin, may be given to destroy any remaining strep bacteria in the body.
Further antibiotics may be prescribed, to prevent recurrence. This may continue for 5-10
years depending on the age of the patient and whether or not the heart was affected.
Long-term, and even lifelong, preventive antibiotics may be necessary to prevent recurring
inflammation of the heart
3. Anti-inflammatory drugs: as or naproxen, may help to reduce pain, inflammation, and fever.
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4. Corticosteroids: as prednisone, may be given if the patient does not respond to first-line anti-
inflammatory medications, or if there is inflammation of the heart.
5. Aspirin: this drug is not usually recommended for children aged under 16 years because of
the risk of developing Reye's syndrome, which can cause liver and brain damage, and even
death, but an exception is usually made in cases of RA because the benefits are greater than
the risks.
6. Anticonvulsant medications: these can treat severe chorea symptoms.
Examples include valproic acid (Depakene or Stavzor), carbamazepine (Carbatrol or
Equetro), haloperidol (Haldol) and risperidone (Risperdal)
Complications
1. Rheumatic heart disease (RHD) is the most common and most serious complication. The
inflammation causes permanent damage to the heart, most commonly the mitral valve, the
valve between the upper and lower chambers of the left side of the heart.
This can lead to:
▪ Valvular stenosis - the valve narrows, causing a drop in blood flow

▪ Valvular regurgitation - blood flows in the wrong direction because of a leak
▪ Heart muscle damage - inflammation weakens the heart muscle so that the heart cannot pump
properly
Other conditions that may develop if there is damage to heart tissue, the mitral valve, or other
heart valves include:
2. Heart failure - a serious condition in which the heart is not pumping blood throughout the
body efficiently. This can affect the left side, the right side, or both sides of the heart.
3. Atrial fibrillation - an abnormal heart rhythm where the upper chambers of the heart (the
atria) do not coordinate with the lower part of the heart (the ventricles). This causes the
heart muscle to contract irregularly and/or excessively fast, making its pumping ability
inefficient. This abnormal rhythm can also lead to a stroke.
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Diseases Measles Mumps Germen measles Chickenpox Rheumatic fever
Causative agent Rubeola virus, a Paramyxovirus group Rubella virus Herpes varicella – zoster Group A beta
paramyxovirus of the (mumps virus) virus. hemolytic
genus Morbillivirus. streptococci (GAS).
Incubation Average is 10-12 Average 16 to 18 days Average is 17 days, Average is 14 to 16 days About 1 to 5 weeks
period days (the range is with a range of 2 to 4 (with a range of 12 to 23 (usually rang 10 to 21)
seven to 21 days). weeks days).
Communicability 4 days before 6 -7 days before to 9 7 days before to 7 days a day or two before the ………………..
period through 4 days after days after onset of after rash onset rash appears and until the
rash onset parotitis rash is completely dry and
scabbed over, about five
to six days after onset of
the rash.
Risk Factors Children aged <5 Children aged 5-15 Children aged 5-9 years, Children aged below 10 Children aged 5 -15
years, aged >20 years years, non-immunized Women of childbearing years years.
age
children.
Signs & Fever, cough, runny Pain, tenderness, and A low-grade fever, Fever, Loss of appetite, Fever, Arthralgia,
Symptoms nose, sore throat, Eye swelling in one or both Headache, Mild pink Headache, Tiredness and painful, tender
redness, Light eye, General discomfort, malaise, Cold, cough,
parotid salivary glands, joints, Fatigue,
sensitivity, Muscle Swollen and enlarged running nose.
Low-grade fever, Chorea,
pain, Koplik's spots. lymph nodes usually in
Malaise, Headache, Subcutaneous
the back of the neck or
Muscle aches, Loss of behind the ears, Cough, nodules, Erythema
appetite, Pain and Runny nose marginatum.
&stiffness on opening
the mouth
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Rash Bright pink or red ……………………… The pink or light red Raised pink or red bumps Erythema
color rashes appear rash generally first (papules), which break out marginatum: A
first at hairline then appears on the face and over several days.
long-lasting reddish
involve face and then spreads to the rest
Small fluid-filled blisters
neck and then on of the body and lasts rash that begins on
(vesicles), forming from
chest and all over about three days. the trunk or arms.
the raised bumps over
body including upper
The rash of German about one day before
and lower limbs.
measles is scattered (not breaking and leaking.
After 5 to 6 days rash flow together as
Crusts and (scabs), which
begin to disappear measles). They leave
cover the broken blisters
leaving brownish some desquamation, but
and take several more
discoloration. not discoloration of skin
days to heal.
as measles
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Typhoid fever
Definition
An acute, highly infectious disease caused by a bacillus (Salmonella typhi), bacterial

infection of the intestines, transmitted chiefly by contaminated food or water
Typhoid fever is contagious because the patient has the bacteria in their stool and blood
that can contaminate food and water sources and thus be transmitted to uninfected people
Causative agent: Typhoid is caused by Salmonella Typhi growing in the intestines and
blood, the typhoid bacillus, and S. paratyphi, with three recognized serovars (A, B and C),
are the infectious agents.
Incubation period: ranges from 7-14 days on average but can range from 3 days to two
months.
Communicability period: The diseases are communicable as long as typhoid or

paratyphoid bacilli are present in excreta. Some patients become permanent carriers.
Mode of transmission:
Contaminated water or food (transmitted by the faecal–oral route).
▪ Poor standards of hygiene in food preparation and handling

▪ Shellfish taken from sewage-polluted areas
▪ Eating raw fruit and vegetables fertilized by human excreta
▪ Ingestion of contaminated milk and milk products.
▪ Flies may cause human infection through transfer of the infectious agents to foods.
Risk factors or group
▪ People who ingest contaminated food.

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▪ Persons who had bad personal hygiene
▪ unsanitary environment
▪ Travelers to areas where typhoid fever is endemic, especially if they fail to become
immunized prior to traveling.
▪ Have close contact with someone who is infected or has recently been infected with
typhoid fever.
Signs and symptoms
Signs and symptoms are likely to develop gradually — often appearing one to three weeks after
exposure to the disease.
Signs and symptoms are likely to develop gradually, often appearing one to three weeks after
exposure to the disease.
Early illness
Once signs and symptoms do appear, you're likely to experience:
• Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)
• Headache
• Loss of appetite and weight loss
• Abdominal pain
• Diarrhea or constipation (adults tend to get constipation while children tend to get diarrhea)
• Weakness and fatigue (malaise)
• Muscle aches
• Sweating
• Rash (rose-colored spots on the chest are seen)
• Extremely swollen abdomen
• Dry cough
Later illness
If you don't receive treatment, you may:

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• Become delirious
• Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid
state
In addition, life-threatening complications often develop at this time.
In some people, signs and symptoms may return up to two weeks after the fever has subsided.
Typhoid carriers
Even after treatment with antibiotics, a small number of people who recover from typhoid
fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years.
These people, called chronic carriers, shed the bacteria in their feces and are capable of
infecting others, although they no longer have signs or symptoms of the disease themselves.
Tests and diagnosis
 Medical and travel history
 Body fluid or tissue culture
• The Widal test.

• A Stool, bone marrow culture.
• A complete blood count (CBC) will show a high number of white blood cells.
• A blood culture during the first week of the fever can show S typhi bacteria.
Management
▪ Antibiotics such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole,

amoxicillin, and ciprofloxacin. Antimicrobial resistance is common with likelihood of
more complicated and expensive treatment options required in the most affected regions.
Even when the symptoms go away, people may still be carrying typhoid bacteria, meaning they
can spread it to others, through shedding of bacteria in their faeces.
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It is important for people being treated for typhoid fever to do the following:
▪ Take prescribed antibiotics for as long as the doctor has prescribed.
▪ Strict personal hygiene. Wash their hands with soap and water after using the bathroom
and avoid preparing or serving food for other people. This will lower the chance of
passing the infection on to someone else.
▪ Have test to ensure that no Salmonella Typhi bacteria remain in their body.
Prevention
▪ Access to safe water
▪ Adequate sanitation
▪ Hygiene among food handlers
▪ Typhoid vaccination “Typhoid conjugate vaccine, is given as a single injectable dose in
children from 6 months of age and in adults up to 45 years or 65 years (depending on
the vaccine)”.
▪ Typhoid fever vaccination should be offered to travelers to destinations where the risk
of typhoid fever is high.
▪ The following recommendations will help ensure safety while travelling:
− Ensure food is properly cooked and still hot when served.
− Avoid raw milk and products made from raw milk. Drink only pasteurized or
boiled milk.
− Avoid ice unless it is made from safe water.
− When the safety of drinking water is questionable, boil it, or if this is not possible,
disinfect it with a reliable, slow-release disinfectant agent (usually available at
pharmacies).
− Wash hands thoroughly and frequently using soap, in particular after contact with
pets or farm animals, or after having been to the toilet.
− Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible,
vegetables and fruits should be peeled.
27
Complications
The 2 most common complications in untreated typhoid fever are:

 Internal bleeding in the digestive system
 Splitting (perforation) of a section of the digestive system or bowel, which spreads the
infection to nearby tissue, to the peritoneum causing peritonitis, into the blood causing
sepsis
28
Hepatitis A
Definition:
▪ Hepatitis A is a type of hepatitis that is caused by the hepatitis A virus (HAV) that can
cause mild to severe illness.
▪ Almost everyone recovers fully from hepatitis A with lifelong immunity.
Causative agent: Hepatitis A is caused by infection with the hepatitis A virus (HAV), a
non-enveloped, positive stranded RNA virus, first identified by electron microscopy in
1973, classified within the genus hepato-virus of the picorna-virus family. The virus
interferes with the liver’s functions while replicating in hepatocytes.
Incubation period: can range from 15 to 45 days and is dependent on the number of virus
particles.
Communicable period: Most infectious 1-2 weeks before onset of illness.
Mode of transmission
▪ The hepatitis A virus is transmitted primarily by the faecal-oral route.

▪ Eating food was prepared by someone with the hepatitis A virus.
▪ Ingests food or water that has been contaminated with the faeces of an infected person.
▪ Waterborne outbreaks, though infrequent, are usually associated with sewage-
contaminated or inadequately treated water.
▪ Close physical contact (such as oral-anal sex) with an infectious person,
▪ Eating sewage-contaminated raw shellfish.
Hepatitis A cannot get from:
• Being coughed or sneezed on by an infected person.

• Sitting next to an infected person.
• Hugging an infected person.
• A baby cannot get hepatitis A from breast milk.
High Risk group
29
❖ Travelers to epidemic area.
❖ Dealing with infected person.
❖ Health team worker.
❖ Children by age 10 living in countries where there are poor sanitation standards
Clinical pictures
The course of acute hepatitis A can be divided into four clinical phases:
• An incubation or preclinical period:
Ranging from 10 to 50 days, during which the patient remains asymptomatic despite active
replication of the virus. In this phase, transmissibility is of greatest concern.
• A prodromal or pre-icteric phase:
Ranging from several days to more than a week, characterized by:
1. Loss of appetite.
2. Fatigue.
3. Abdominal pain.
4. Nausea and vomiting.
5. Fever.
6. Diarrhea.
7. Dark urine.
8. Pale stools.
• An icteric phase:
The icteric phase generally begins within 10 days of the initial symptoms.
1. Jaundice develops at total bilirubin levels exceeding 20 - 40 mg/l.
2. Fever usually improves after the first few days of jaundice.
3. Faeces remain infectious for another 1 -2 weeks.
4. Extensive necrosis of the liver occurs during the first 6 - 8 weeks of illness.
5. Marked abdominal pain
6. Vomiting
30
7. Hepatic encephalopathy
8. Coma and seizures,
9. Death in 70 -90% of the patients.
• A convalescent period:
Where resolution of the disease is slow, but patient recovery uneventful and Complete.
Relapsing hepatitis occurs in 3 - 20% of patients 4 to 15 weeks after the initial symptoms have
resolved. Cholestatic hepatitis with high bilirubin levels persisting for months is also
occasionally observed. Chronic sequelae with persistence of HAV infection for more than 12
months are not observed.
Diagnostic Measures
1. Medical history and Physical examination to see if liver is enlarged and tender.
2. Laboratory tests.
✓ Detection of HAV-specific immunoglobulin G (IgM) antibodies in the blood.

✓ RT-PCR to detect the hepatitis A virus RNA
✓ Elevated liver functions as direct serum bilirubin, AST, ALT, alkaline
phosphatase, prothrombin time, total protein, albumin.
Treatment
▪ There is no specific treatment for hepatitis A. Recovery from symptoms following

infection may be slow and can take several weeks or months. It is important to avoid
unnecessary medications that can adversely affect the liver, e.g. acetaminophen,
paracetamol.
▪ Hospitalization is unnecessary in the absence of acute liver failure.
▪ Therapy is aimed at maintaining comfort and adequate nutritional balance, including
replacement of fluids that are lost from vomiting and diarrhea.
31
▪ Vaccination to prevent infection if given within 2 weeks of contact. A second vaccine
given in 6-12 months is recommended to provide long lasting protection
▪ Children with hepatitis A should be excluded from school or childcare until a medical
certificate of recovery is received and until 7 days after the onset of jaundice.
Prevention:
Improved sanitation, food safety and immunization are the most effective ways to combat
hepatitis A.
▪ Adequate supplies of safe drinking water;
▪ Proper disposal of sewage within communities;
▪ Personal hygiene practices such as regular handwashing before meals and after going to
the bathroom.
Complications:
Severe clinical manifestations of hepatitis A infection are rare; however, atypical
complications may occur, including immunologic, neurologic, hematologic, pancreatic,
and renal manifestations.
Relapsing hepatitis, cholestatic hepatitis A, hepatitis A triggering autoimmune hepatitis,
subfulminant hepatitis, and fulminant hepatitis have also been reported.
32
Ascariasis
Definition
Ascaris is an intestinal parasite of humans. It is the most common human worm infection.
known as soil-transmitted helminths (The larvae and adult worms live in the small
intestine and can cause intestinal disease.
Ascaris lumbricoides is the giant roundworm of humans, growing to a length of up to 35
cm (14 in). It is one of several species of Ascaris.
An ascarid nematode of the phylum Nematode, it is the largest and most common
parasitic worm in humans. This organism is responsible for the disease ascariasis, a type
of helminthiasis and one of the groups of neglected tropical diseases.
An estimated one-sixth of the human population is infected by A. lumbricoides or another
roundworm. Ascariasis is prevalent worldwide, especially in tropical and subtropical
countries.
Incubation period: is variable because the parasite's life cycle may take four to eight weeks
to be completed.
Life cycle (causative agent, diagnostic stage, infective stage)
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.
33
People infected with Ascaris often show no symptoms.
If symptoms do occur they can be light and include
1-abdominal discomfort
2-. Heavy infections can cause intestinal blockage and impair growth in children
3-Migrating adult worms may cause cough, symptomatic occlusion of the biliary tract,
appendicitis, or nasopharyngeal expulsion, particularly in infections involving a single female
worm.
34
Risk factors
1. Infection occurs worldwide in warm and humid climates

2. Sanitation and hygiene are poor, also Persons in these areas are at risk if soil
contaminated with human feces enters their mouths
3, People who raise pigs or use raw pig manure as fertilizer may be at risk.
4. The high-risk groups identified by the World Health Organization are preschool and school-
age children, women of childbearing age (including pregnant women in the 2nd and 3rd
trimesters and lactating women) and adults in occupations where there is a high risk of
heavy infections.
5. If they eat vegetables or fruit that have not been carefully washed, peeled or cooked.
Ascaris lives in the intestine and Ascaris eggs are passed in the feces of infected persons. If the
infected person defecates outside (near bushes, in a garden, or field), or if the feces of an
infected person are used as fertilizer, then eggs are deposited on the soil. They can then mature
into a form that is infective. Ascariasis is caused by ingesting infective eggs. This can happen
when hands or fingers that have contaminated dirt on them are put in the mouth or by
consuming vegetables or fruits that have not been carefully cooked, washed or peeled.

Health care providers can diagnose ascariasis by taking a stool sample and using a microscope
to look for the presence of eggs. Some people notice infection when a worm is passed in their
stool or is coughed up. If this happens, bring in the worm specimen to your health care provider
for diagnosis.
35
Prevention:
1. Avoid contact with soil that may be contaminated with human feces, including with
human fecal matter ("night soil") used to fertilize crops.
2. Wash your hands with soap and warm water before handling food
3. Teach children the importance of washing hands to prevent infection
4. Wash, peel, or cook all raw vegetables and fruits before eating, particularly those that have
been grown in soil that has been fertilized with manure.
5. Transmission of Ascaris lumbricoides infection to others in a community setting can be
prevented by:
A. Not defecating outdoors.
B. Effective sewage disposal systems.
Treatment:
Anthelminthic medications (drugs that rid the body of parasitic worms), such as albendazole
and mebendazole, are the drugs of choice for treatment. Infections are generally treated for 1-3
days. The recommended medications are effective.
Complications
• Bleeding per rectum
• Bowel obstruction
• Appendicitis
• Hepatobiliary disease
• Pancreatic pseudocyst
36
Pin worm (Enterobiasis)
Definition
A pinworm infection is an extremely common infection in which tiny worms infest the
intestines and lay eggs around the anus.
Life cycle
Infective stage: Embryonated eggs
Incubation period:1 to 2 months or longer for the adult gravid female to mature in the small
intestine.
Diagnostic stage: eggs on perianal folds
The lifecycle begins with eggs being ingested. The eggs hatch in the duodenum (i.e., first part
of the small intestine). The emerging pinworm larvae grow rapidly to a size of 140 to 150
37
micrometers in size and migrate through the small intestine towards the colon. During this
migration they moult twice and become adults. Females survive for 5 to 13 weeks, and males
about 7 weeks. The male and female pinworms mate in the ileum (i.e., last part of the small
intestine) where after the male pinworms usually die, and are passed out with stool. The gravid
female pinworms settle in the ileum, caecum (i.e., beginning of the large
intestine), appendix and ascending colon, where they attach themselves to the mucosa and
ingest colonic contents. Almost the entire body of a gravid female becomes filled with
eggs. The estimations of the number of eggs in a gravid female pinworm ranges from about
11,000 to 16,000. The egg-laying process begins approximately five weeks after initial
ingestion of pinworm eggs by the human host. The gravid female pinworms migrate through
the colon towards the rectum at a rate of 12 to 14 centimeters per hour. They emerge from
the anus, and while moving on the skin near the anus, the female pinworms deposit eggs either
through (1) contracting and expelling the eggs, (2) dying and then disintegrating, or (3) bodily
rupture due to the host scratching the worm. After depositing the eggs, the female becomes
opaque and dies. The reason the female emerges from the anus is to obtain the oxygen
necessary for the maturation of the eggs.
Clinical manifestation (Signs & Symptoms)

Some individuals with pinworm infections may not experience any symptoms. However, when
suspect that there is a pinworm infection, notice that :
• Frequent and strong itching of the anal area
• Restless sleep due to itching and discomfort of anal area ,teeth grinding, or even
abdominal pain
• Pain, rash, or other skin irritation around the anus
• Presence of pinworms in the area of your child’s anus
• Presence of pinworms in stools.
38
Risk Factors
Pinworm infections affect people of all ages and geographical regions. Since the pinworm eggs
are microscopic, it’s impossible to avoid infected individuals or areas.
While anyone can get a pinworm infection, the following groups are more susceptible:
• Children who attend day care, preschool, or elementary school
• Family members or caregivers of infected children and adults
• Individuals who live in institutions or other crowded accommodations
• Children or adults who don’t practice regular and careful hand washing prior to eating
Children who have a habit of sucking their thumbs.
1. Pinworm infection spreads through human-to-human transmission, by ingesting
(i.e., swallowing) infectious pinworm eggs.

The eggs are hardy and can remain viable in a moist environment for up to three weeks, though
in a warm dry environment they usually last only 1-2days. They do not tolerate heat well, but
can survive in low temperatures: at −8 degrees Celsius (18 °F), two-thirds of the eggs are still
viable after 18 hours.
After the eggs have been initially deposited near the anus, they are readily transmitted to other
surfaces through contamination. The surface of the eggs is sticky when laid, and the eggs are
readily transmitted from their initial deposit near the anus to fingernails, hands, night-clothing
and bed linen. From here, eggs are further transmitted to food, water, furniture, toys,
bathroom fixtures and other objects. Household pets often carry the eggs in their fur, while not
actually being infected.
39
2. Dust containing eggs can become airborne and widely dispersed when dislodged
from surfaces, for instance when shaking out bed clothes and linen.
Consequently, the eggs can enter the mouth and nose through inhalation, and be swallowed
later. Although pinworms do not strictly multiply inside the body of their human host,some of
the pinworm larvae may hatch on the anal mucosa, and migrate up the bowel and back into
the gastrointestinal tract of the original host.

A tape test is the most reliable method for diagnosing a pinworm infection. A tape test consists
of taking a piece of cellophane tape and pressing the sticky, adhesive side against the skin
around the anus. Since pinworms often exit the anus while the infected person sleeps, should
conduct a tape test upon waking in the morning. If eggs are present, they will stick to the tape.
Take the tape to doctor, who can place it on a slide and examine it under a microscope to see if
it contains pinworm eggs.
Routine morning activities, such as bathing or using the toilet, can remove eggs from your skin,
so the results of a tape test are most accurate if you perform the test when you first wake up.
The CDC recommends that you conduct a tape test at least three times.

Prevention:
▪ Practice good hygiene. Washing your hands before eating or preparing meals helps prevent
spread of infection.
▪ Avoid scratching the anal region.
▪ Avoid biting the fingernails.
▪ Keep fingernails short and clean.
▪ Wash all bedding and pajamas regularly.
▪ Be sure your child changes underwear daily.
▪ Shower daily in the morning to remove pinworm eggs that may have been deposited
overnight.
40
▪ Keep rooms well lit during the day because the eggs are sensitive to sunlight.
▪ Carefully vacuum all carpeted areas.
▪ Avoid shaking clothing and bedding to keep pinworm eggs from spreading into the air.
Treatment:
Doctor can usually treat a pinworm infection effectively with oral medication. Since
pinworms pass so easily from one person to another, everyone living in the household of an
infected person usually needs treatment at the same time to prevent reinfection. Caregivers
and others who have close, personal contact with the individual also receive treatment.
The most common and effective medications to treat pinworm infection are:
• Mebendazole
• Albendazole (Albenza)
• Pyrantelpamoate
One course of medication usually involves an initial dose, followed by a second dose two to
three weeks later. More than one course may be necessary to fully eliminate the pinworm eggs.
Creams or ointments can soothe itching skin in the area around the anus.
Complications
Most people don’t experience serious complications from pinworm infections, but in rare cases
the following complications can occur:
• Urinary tract infections (UTIs). UTIs can develop if you do not treat the pinworm
infection.
• Vaginitis and endometritis. Endometritis infections can occur if pinworms travel from
the anus to the vagina, affecting the uterus, fallopian tubes, and other pelvic organs.
• Abdominal pain. The presence of a significant amount of pinworms can cause
discomfort.
• Weight loss. Substantial pinworm populations can reduce your intake of essential
nutrients and cause weight loss.
41
Schistosomiasis
Definition
Schistosomiasis, also known as bilharzia, snail fever, and Katayama fever is

a disease caused by parasitic flatworms of the Schistosoma type. The urinary tract or
the intestines may be infected
Causal Agents:
Schistosomiasis is caused by digenetic blood trematodes.
The three main species infecting humans are Schistosoma haematobium, S. mansoni and S.
japonicum.
Two other species, more localized geographically, are S. mekongi and S. intercalatum.
Life cycle (infective stage, Diagnostic stage):

• Eggs are eliminated with feces or urine (Diagnostic stage) (1).
• Under optimal conditions the eggs hatch and release miracidia (2)
• Which swim and penetrate specific snail (intermediate hosts) (3)
• The stages in the snail include 2 generations of sporocysts (4)
• And the production of cercariae (5). (Infective stage)
• Upon release from the snail, the infective cercariae swim, penetrate the skin of the human
host(6)
• And shed their forked tail, becoming schistosomulae (7).
• The schistosomulae migrate through several tissues and stages to their residence in the
veins (8,9).
• Adult worms in humans reside in the mesenteric venules in various locations, which at
times seem to be specific for each species (10).
42
Clinical manifestations (Signs &Symptoms)
❖ The incubation period is typically 14–84 days for acute schistosomiasis (Katayama
syndrome), but chronic infection can remain asymptomatic for years.
❖ Acute schistosomiasis is characterized by:
1-Fever 2 - Headache
3- Headache 4 - Myalgia
5- Diarrhea and respiratory symptoms.
6- Eosinophilia is present
7- as well as often painful hepatomegaly or splenomegaly.
43
❖ Chronic schistosomiasis:
• Are the results of host immune responses to schistosome eggs.
• Eggs secreted by adult worm pairs enter the circulation and lodge in organs and cause
granulomatous reactions.
• Eosinophilia may be present.
• S. mansoni and S. japonicum eggs most commonly lodge in the blood vessels of the
liver or intestine and can cause:
- Diarrhea
- Constipation
- Blood in the stool.
• Chronic inflammation can lead to bowel wall ulceration, hyperplasia, and
polyposis and, with heavy infections, to liver fibrosis and portal hypertension.
• S. haematobium eggs tend to lodge in the urinary tract causing damage, dysuria
and hematuria.
• S. haematobium infection can also cause genital symptoms and has been
associated with increased risk of bladder cancer.
❖ Rarely, central nervous system schistosomiasis may develop; this form is thought to
result from aberrant migration of adult worms or eggs depositing in the spinal cord or
brain. Signs and symptoms are related to ectopic granulomas in the central nervous
system and can present as transverse myelitis

Risk factors
1. Males are high risk for infection than females.

2. The age groups between 10-19 years (school-aged children in endemic areas) and 20-30
years are high risk for infection.
44
3. Individuals practicing leisure activities (Bathing, Swimming) in contaminated water.
People are infected during routine agricultural, domestic, occupational and recreational
activities which expose them to infested water. Lack of hygiene and certain play habits of
school-aged children such as swimming or fishing in infested water make them especially
vulnerable to infection.
• Infection occurs when your skin comes in contact with contaminated freshwater in
which certain types of snails that carry schistosomes are living.
• Freshwater becomes contaminated by Schistosoma eggs when infected people urinate
or defecate in the water.
• The eggs hatch, and if certain types of freshwater snails are present in the water, the
parasites develop and multiply inside the snails.
• The parasite leaves the snail and enters the water where it can survive for about 48
hours.
• Schistosoma parasites can penetrate the skin of persons who are wading, swimming,
bathing, or washing in contaminated water.
• Within several weeks, parasite mature into adult worms, residing in the blood vessels of
the body where the females produce eggs.
• Some of the eggs travel to the bladder or intestine and are passed into the urine or stool.
• Stool or urine samples can be examined microscopically for parasite eggs (stool
for S. mansoni or S. japonicum eggs and urine for S. haematobium eggs).
• The eggs tend to be passed intermittently and in small amounts and may not be
detected, so it may be necessary to perform a blood (serologic) test.
• For accurate results, you must wait 6-8 weeks after your last exposure to contaminated
water before the blood sample is taken.
45
 Prevention & control:
• Preventive chemotherapy and snail control are measures that need to continuously be
applied to reduce morbidity and transmission
✓ Untreated piped water coming directly from freshwater sources may contain
cercariae, but filtering with fine-mesh filters, heating bathing water to 122°F (50°C)
for 5 minutes, or allowing water to stand for ≥24 hours before exposure can
eliminate risk for infection
✓ Topical applications of insect repellents such as DEET can block penetrating
cercariae, but the effect depends on the repellent formulation, may be short-lived,
and cannot reliably prevent infection
• More sustainable and long-lasting efforts to prevent infection and reinfection include
health education and behavior change interventions as well as improvements in the
water and sanitation infrastructure in at-risk communities.
Behavior change interventions
o One needs to be aware that increased knowledge about how to prevent
infection, How to reduce transmission
o The motivation for behavioral change in deprived communities need to go
hand-in-hand with the accessibility of safe water sources and improved
sanitation.
.
✓ Ceasing urination into open water bodies can inhibit the transmission of S. haematobium.
✓ While also refraining from open defecation in or near water bodies can lower the
transmission of S. guineensis, S. intercalatum, S. japonicum, S. mansoni and S. mekongi,
✓ Preventive measures are primarily avoiding wading, swimming, or other contact with
freshwater in disease-endemic countries.
✓ Swimming in adequately chlorinated swimming pools is virtually always safe, even in
disease-endemic countries.
46
✓ Vigorous towel-drying after accidental exposure to water has been suggested as a way to
remove cercariae before they can penetrate, but this may only prevent some infections
and should not be recommended as a preventive measure.
Management
• Infections with all major Schistosoma species can be treated with praziquantel.
• The timing of treatment is important since praziquantel is most effective against the adult
worm and requires the presence of a mature antibody response to the parasite.
• For travelers, treatment should be at least 6-8 weeks after last exposure to potentially
contaminated freshwater. One study has suggested an effect of praziquantel on
schistosome eggs lodged in tissues.
• Limited evidence of parasite resistance to praziquantel has been reported based on low
cure rates in recently exposed or heavily infected populations; however, widespread
clinical resistance has not occurred.
• Thus, praziquantel remains the drug of choice for treatment of schistosomiasis.
• Host immune response differences may impact individual response to treatment with
praziquantel.
• Although a single course of treatment is usually curative, the immune response in lightly
infected patients may be less robust, and repeat treatment may be needed after 2 to 4
weeks to increase effectiveness.
• If the pre-treatment stool or urine examination was positive for schistosome eggs, follow
up examination at 1 to 2 months post-treatment is suggested to help confirm successful
cure.
Schistosoma species infection Praziquantel dose and Duration
Schistosoma mansoni, S. 40 mg/kg per day orally in two
haematobium, S. intercalatum divided doses for one day
S. japonicum, S. mekongi 60 mg/kg per day orally in three

divided doses for one day
47
Complications
• Gastrointestinal (GI) bleeding - GI obstruction

• Malnutrition - Schistosomal nephropathy
• Renal failure -Pyelonephritis
• Hematuria -Hemospermia
• Squamous cell bladder cancer -Sepsis (Salmonella)
• Pulmonary hypertension or pulmonale
• Neuroschistosomiasis - Transverse myelitis, paralysis, and cerebral microinfarcts
• Infertility - Severe anemia
• Low ̶ birth-weight babies - Spontaneous abortion
• Higher risk for ectopic pregnancies -End-organ disease
• Portal hypertension - Obstructive uropathy
• Pregnancy complications from vulvar or fallopian granuloma
• Carcinoma of the liver, bladder, or gallbladder
48
Diseases Ascariasis Pin worm Shistosomiasis
Causative agent Ascaris lumbricoides Enterobius vermicularis. Schistosoma haematobium, S. mansoni
and S. japonicum.
Incubation period Take 4 to 8 weeks to be 1 to 2 months or longer 14 - 84 day
completed.
Risk Factors warm and humid climates, Children who attend day care, Males more than females, school-aged
poor sanitation and hygiene, preschool, or elementary children in endemic areas and people at
preschool and school-age school, crowded places, poor 20-30 years, activities in contaminated
children, women of hand washing. water.
childbearing age
Signs & Symptoms Abdominal discomfort or pain, Frequent and strong itching of Fever, Headache, myalgia
cough the anal area, Restless sleep, Diarrhea, Constipation, Blood in the
teeth grinding, or even stool, dysuria and hematuria.
abdominal pain.
Diagnostic measures Stool sample A tape test Stool or urine samples, Blood
(serologic) test.
Management Mebendazole, Albendazole Mebendazole, Albendazole Praziquantel
(Albenza), Pyrantelpamoate
49
Iron Deficiency Anemia
Iron-deficiency anemia is a blood disorder that affects your red blood cells. It’s the most
common form of anemia. It happens when your body doesn’t have enough iron to make
hemoglobin, a substance in your red blood cell that allows them to carry oxygen throughout your
body. As a result, iron deficiency may cause you to feel short of breath or tired. These symptoms
develop over time. When iron deficiency is diagnosed, you may be prescribed iron supplements.
Healthcare providers will also ask questions and do tests to determine why you developed iron
deficiency.
✓ Prevalence:
According to WHO, in 2019, global anemia prevalence was 29.9% (95% uncertainty
interval (UI) 27.0%, 32.8%) in women of reproductive age, equivalent to over half a billion
women aged 15-49 years. Prevalence was 29.6% (95% UI 26.6%, 32.5%) in non-pregnant
women of reproductive age, and 36.5% (95% UI 34.0%, 39.1%) in pregnant women.
In 2019, global anemia prevalence was 39.8% (95% UI 36.0%, 43.8%) in children aged 6-
59 months, equivalent to 269 million children with anemia. The prevalence of anemia in children
under five was highest in the African Region, 60.2% (95% UI 56.6%, 63.7%).
✓ Clinical Features:
Symptoms of iron-deficiency anemia are related to decreased oxygen delivery to the entire
body and may include:
• Being pale or having yellow "sallow" skin
• Unexplained fatigue or lack of energy
• Shortness of breath or chest pain, especially with activity
• Unexplained generalized weakness
50
• Rapid heartbeat
• Pounding or "whooshing" in the ears
• Headache, especially with activity
• Craving for ice or clay - "picophagia"
• Sore or smooth tongue
• Brittle nails or hair loss
✓ Causes of Iron deficiency anemia:
Iron deficiency anemia occurs when your body doesn't have enough iron to produce
hemoglobin. Hemoglobin is the part of red blood cells that gives blood its red color and enables
the red blood cells to carry oxygenated blood throughout your body. If you aren't consuming
enough iron, or if you're losing too much iron, your body can't produce enough hemoglobin, and
iron deficiency anemia will eventually develop.
Causes of iron deficiency anemia include:
• Blood loss. Blood contains iron within red blood cells. So if you lose blood, you lose some
iron. Women with heavy periods are at risk of iron deficiency anemia because they lose
blood during menstruation. Slow, chronic blood loss within the body such as from a peptic
ulcer, a hiatal hernia, a colon polyp or colorectal cancer can cause iron deficiency anemia.
Gastrointestinal bleeding can result from regular use of some over-the-counter pain
relievers, especially aspirin, Also, frequent blood donations.
• A lack of iron in your diet. Your body regularly gets iron from the foods you eat. If you
consume too little iron, over time your body can become iron deficient. Examples of iron-
rich foods include meat, eggs, leafy green vegetables and iron-fortified foods. For proper
growth and development, infants and children need iron from their diets, too.
• An inability to absorb iron. Iron from food is absorbed into your bloodstream in your
small intestine. An intestinal disorder, such as celiac disease, which affects your intestine's
51
ability to absorb nutrients from digested food, can lead to iron deficiency anemia. If part
of your small intestine has been bypassed or removed surgically, that may affect your
ability to absorb iron and other nutrients.
• Pregnancy. Without iron supplementation, iron deficiency anemia occurs in many

pregnant women because their iron stores need to serve their own increased blood volume
as well as be a source of hemoglobin for the growing fetus.
✓ Risk factors:
These groups of people may have an increased risk of iron deficiency anemia:
• Women. Because women lose blood during menstruation, women in general are at greater
risk of iron deficiency anemia.
• Infants and children. Infants, especially those who were low birth weight or born
prematurely, who don't get enough iron from breast milk or formula may be at risk of iron
deficiency. Children need extra iron during growth spurts. If your child isn't eating a
healthy, varied diet, he or she may be at risk of anemia.
• Vegetarians. People who don't eat meat may have a greater risk of iron deficiency anemia
if they don't eat other iron-rich foods.
• Frequent blood donors. People who routinely donate blood may have an increased risk
of iron deficiency anemia since blood donation can deplete iron stores. Low hemoglobin
related to blood donation may be a temporary problem remedied by eating more iron-rich
foods. If you're told that you can't donate blood because of low hemoglobin, ask your doctor
whether you should be concerned.
✓ Complications:
Mild iron deficiency anemia usually doesn't cause complications. However, left untreated,
iron deficiency anemia can become severe and lead to health problems, including the following:
52
• Heart problems. Iron deficiency anemia may lead to a rapid or irregular heartbeat. Your
heart must pump more blood to compensate for the lack of oxygen carried in your blood
when you're anemic. This can lead to an enlarged heart or heart failure.
• Problems during pregnancy. In pregnant women, severe iron deficiency anemia has been
linked to premature births and low birth weight babies. But the condition is preventable in
pregnant women who receive iron supplements as part of their prenatal care.
• Growth problems. In infants and children, severe iron deficiency can lead to anemia as
well as delayed growth and development. Additionally, iron deficiency anemia is
associated with an increased susceptibility to infections.
✓ Diagnostic Procedures:
The tests used most often to detect iron deficiency include hemoglobin (the iron-containing
protein in the blood), serum ferritin, which indicates the amount of iron stored in the body, and
serum iron and iron-binding capacity (IBC, UIBC or TIBC).
These measures are used to calculate transferrin-iron saturation percentage (TS%), a

measure of iron in transit in the serum. Serum ferritin is a very important test because it helps
distinguish between iron deficiency anemia and anemia of chronic disease (also called anemia of
inflammatory response). In cases of iron deficiency anemia, iron supplements can be helpful; but
in cases of anemia of chronic disease, iron supplements could be harmful.
Other tests might include: a complete blood count, zinc protoporphyrin, free erythrocyte
protoporphyrin or reticulocyte hemoglobin content (CHr).
A diagnosis of iron deficiency can be made when a person has both low hemoglobin and
hematocrit and low serum ferritin. Serum iron and transferrin-iron saturation percentage will also
be low in a person who is iron deficient. Iron deficiency without anemia can occur when a person
has a normal hemoglobin, but below normal serum ferritin and/or transferrin saturation. Iron
deficiency with anemia can occur when a person has low values of both serum ferritin and
hemoglobin.
53
Prevention:
✓ You can reduce your risk of iron deficiency anemia by choosing iron-rich foods.
Choose iron-rich foods include:
• Legumes: Peas, beans, tofu and tempeh.

• Breads and cereals: Whole wheat bread, enriched white bread, rye bread, bran cereals
and cereals with wheat.
• Vegetables: Spinach, broccoli, string beans, dark leafy greens, potatoes, cabbage,
Brussels sprouts and tomatoes.
• Protein: Beef, poultry, eggs, liver and fish, including shellfish.
• Fruit: Figs, dates and raisins.
Your body absorbs more iron from meat than it does from other sources. If you choose to not eat
meat, you may need to increase your intake of iron-rich, plant-based foods to absorb the same
amount of iron as does someone who eats meat.
✓ Choose foods containing vitamin C to enhance iron absorption:
You can enhance your body's absorption of iron by drinking citrus juice or eating other foods rich
in vitamin C at the same time that you eat high-iron foods. Vitamin C in citrus juices, like orange
juice, helps your body to better absorb dietary iron.
Vitamin C is also found in:
• Broccoli
• Grapefruit
• Kiwi
• Leafy greens
• Melons
• Oranges
• Peppers
54
• Strawberries
• Tangerines
• Tomatoes
Preventing iron deficiency anemia in infants:
To prevent iron deficiency anemia in infants, feed your baby breast milk or iron-fortified
formula for the first year. Cow's milk isn't a good source of iron for babies and isn't recommended
for infants under 1 year. After age 6 months, start feeding your baby iron-fortified cereals or
pureed meats at least twice a day to boost iron intake. After one year, be sure children don't drink
more than 20 ounces (591 milliliters) of milk a day. Too much milk often takes the place of other
foods, including those that are rich in iron.
Treatment:
Even if the cause of the iron deficiency can be identified and treated, it is still usually
necessary to take medicinal iron (more iron than a multivitamin can provide) until the deficiency
is corrected and the body's iron stores are replenished. In some cases, if the cause cannot be
identified or corrected, the patient may have to receive supplemental iron on an ongoing basis.
There are several ways to increase iron intake:
➢ Diet
• Meat: beef, pork, or lamb, especially organ meats such as liver
• Poultry: chicken, turkey, and duck, especially liver and dark meat
• Fish, especially shellfish, sardines, and anchovies
• Leafy green members of the cabbage family including broccoli, kale, turnip greens, and
collard greens
• Legumes, including lima beans, peas, pinto beans, and black-eyed peas
• Iron-enriched pastas, grains, rice, and cereals

55
➢ Medicinal Iron
The amount of iron needed to treat patients with iron deficiency is higher than the amount
found in most daily multivitamin supplements. The amount of iron prescribed by your doctor will
be in milligrams (mg) of elemental iron. Most people with iron deficiency need 150-200 mg per
day of elemental iron (2 to 5 mg of iron per kilogram of body weight per day). Ask your doctor
how many milligrams of iron you should be taking per day. If you take vitamins, bring them to
your doctor's visit to be sure.
There is no evidence that any one type of iron salt, liquid, or pill is better than the others,
and the amount of elemental iron varies with different preparations. To be sure of the amount of
iron in a product, check the packaging. In addition to elemental iron, the iron salt content (ferrous
sulfate, fumarate, or gluconate) may also be listed on the package, which can make it confusing
for consumers to know how many tablets or how much liquid to take to get the proper dosage of
iron.
Iron is absorbed in the small intestine (duodenum and first part of the jejunum). This means
that enteric-coated iron tablets may not work as well. If you take antacids, you should take iron
tablets two hours before or four hours after the antacid. Vitamin C (ascorbic acid) improves iron
absorption, and some doctors recommend that you take 250 mg of vitamin C with iron tablets.
Possible side effects of iron tablets include abdominal discomfort, nausea, vomiting,
diarrhea, constipation, and dark stools.
➢ Intravenous Iron
In some cases your doctor may recommend intravenous (IV) iron. IV iron may be necessary
to treat iron deficiency in patients who do not absorb iron well in the gastrointestinal tract, patients
with severe iron deficiency or chronic blood loss, patients who are receiving supplemental
erythropoietin, a hormone that stimulates blood production, or patients who cannot tolerate oral
iron. If you need IV iron, your doctor may refer you to a hematologist to supervise the iron
infusions. IV iron comes in different preparations:
56
• Iron dextran
• Iron sucrose
• Ferric gluconate
Large doses of iron can be given at one time when using iron dextran. Iron sucrose and
ferric gluconate require more frequent doses spread over several weeks. Some patients may have
an allergic reaction to IV iron, so a test dose may be administered before the first infusion. Allergic
reactions are more common with iron dextran and may necessitate switching to a different
preparation. Severe side effects other than allergic reactions are rare and include urticaria (hives),
pruritus (itching), and muscle and joint pain.
➢ Blood Transfusions
Red blood cell transfusions may be given to patients with severe iron-deficiency anemia
who are actively bleeding or have significant symptoms such as chest pain, shortness of breath,
or weakness. Transfusions are given to replace deficient red blood cells and will not completely
correct the iron deficiency. Red blood cell transfusions will only provide temporary improvement.
It is important to find out why you are anemic and treat the cause as well as the symptoms.
57
Juvenile diabetes
Type 1 diabetes is a chronic (life-long) autoimmune disease that prevents your pancreas from
making insulin. If you don’t have enough insulin, too much sugar builds up in your blood,
causing hyperglycemia (high blood sugar), and your body can’t use the food you eat for energy.
This can lead to serious health problems or even death if it’s not treated. People with Type 1
diabetes need synthetic insulin every day in order to live and be healthy.
Type 1 diabetes was previously known as juvenile diabetes and insulin-dependent diabetes.
It requires daily management with insulin injections and blood sugar monitoring. Both children
and adults can be diagnosed with Type 1 diabetes.
❖ Causes:
Type 1 diabetes develops when your immune system mistakenly attacks and destroys cells
in your pancreas that make insulin. This destruction can happen over months or years, ultimately
resulting in a total lack (deficiency) of insulin.
Although scientists don’t yet know the exact cause of Type 1 diabetes, they believe there’s a
strong genetic component. The risk of developing the disease with no family history is
approximately 0.4%. If your biological mother has Type 1 diabetes, your risk is 1% to 4%, and
your risk is 3% to 8% if your biological father has it. If both of your biological parents have Type
1 diabetes, your risk of developing the condition is as high as 30%.
Scientists believe that certain factors, such as a virus or environmental toxins, can trigger
your immune system to attack cells in your pancreas if you have a genetic predisposition for
developing Type 1 diabetes.
❖ Risk factors:
• Genetic factors
The presence of certain genes indicates an increased risk of developing type 1 diabetes.
• Environmental factors
58
Extra genetic factors also may contribute. Potential triggers for immunologically mediated
destruction of the beta cells include viruses (e.g., enterovirus, mumps, rubella, and coxsackievirus
B4), toxic chemicals, and exposure to cow’s milk in infancy, and cytotoxins.
• Immunologic factors
• Age: Although type 1 diabetes can appear at any age, it appears at two noticeable peaks. The
first peak occurs in children between 4 and 7 years old, and the second is in children between
10 and 14 years old.
❖ Signs and symptoms:
Symptoms of Type 1 diabetes typically start mild and get progressively worse or more
intense, which could happen over several days, weeks or months. This is because your pancreas
makes less and less insulin.
Symptoms of Type 1 diabetes include:
• Excessive thirst.
• Frequent urination, including frequent full diapers in infants and bedwetting in children.
• Excessive hunger.
• Unexplained weight loss.
• Fatigue.
• Blurred vision.
• Slow healing of cuts and sores.
• Vaginal yeast infections.
If you or your child has these symptoms, it’s essential to see your healthcare provider and
ask to be tested for Type 1 diabetes as soon as possible. The sooner you’re diagnosed, the better.
59
If a diagnosis is delayed, untreated Type 1 diabetes can be life-threatening due to a
complication called diabetes-related ketoacidosis (DKA). Seek emergency medical care if you or
your child are experiencing any combination of the following symptoms:
• Fruity-smelling breath.
• Nausea and vomiting.
• Abdominal (stomach) pain.
• Rapid breathing.
• Confusion.
• Drowsiness.
• Loss of consciousness.
❖ Diagnosis:
Type 1 diabetes is relatively simple to diagnose. If you or your child has symptoms of Type
1 diabetes, your healthcare provider will order the following tests:
• Blood glucose test: Your healthcare provider uses a blood glucose test to check the amount
of sugar in your blood. They may ask you to do a random test (without fasting) and a fasting
test (no food or drink for at least eight hours before the test). If the result shows that you
have very high blood sugar, it typically means you have Type 1 diabetes.
• Glycosylated hemoglobin test (A1C): If blood glucose test results indicate that you have
diabetes, your healthcare provider may do an A1C test. This measures your average blood
sugar levels over three months.
• Antibody test: This blood test checks for autoantibodies to determine if you have Type 1
or Type 2 diabetes. Autoantibodies are proteins that attack your body’s tissue by mistake.
The presence of certain autoantibodies means you have Type 1 diabetes. Autoantibodies
usually aren’t present in people who have Type 2 diabetes.
60
Your provider will also likely order the following tests to assess your overall health and to
check if you have diabetes-related ketoacidosis, a serious acute complication of undiagnosed or
untreated Type 1 diabetes:
• Basic metabolic panel: This is a blood sample test that measures eight different substances
in your blood. The panel provides helpful information about your body's chemical balance
and metabolism.
• Urinalysis: A urinalysis (also known as a urine test) is a test that examines the visual,
chemical and microscopic aspects of your urine (pee). Providers use it to measure several
different aspects of your urine. In the case of a Type 1 diagnosis, they’ll likely order the
test to check for ketones, which is a substance your body releases when it has to break
down fat for energy instead of using glucose. A high amount of ketones causes your blood
to become acidic, which can be life-threatening.
• Arterial blood gas: An arterial blood gas (ABG) test is a blood test that requires a sample
from an artery in your body to measure the levels of oxygen and carbon dioxide in your
blood.
❖ Treatment:
Type 1 diabetes occurs because your body can't produce enough insulin. This means you'll
need regular insulin treatment to keep your glucose levels normal.
Insulin comes in several different preparations, each of which works slightly differently. For
example, some last up to a whole day (long-acting), some last up to eight hours (short-acting) and
some work quickly but don't last very long (rapid-acting).Treatment is likely to include a
combination of these different insulin preparations.
The methods of injecting insulin include:
• Syringes
• Insulin pens that use pre-filled cartridges and a fine needle
61
• Jet injectors that use high pressure air to send a spray of insulin through the skin
• Insulin pumps that dispense insulin through flexible tubing to a catheter under the skin of
the abdomen
❖ Management:
Type 1- diabetes is a life-threatening condition which needs to be closely managed with

daily care. Type 1 diabetes is managed with:
• Insulin replacement through lifelong insulin injections (up to 6 every day) or use of an
insulin pump.
• Monitoring of blood glucose levels regularly (up to 6 times every day or as directed by a
doctor or Credentialed Diabetes Educator). Measuring blood glucose yourself every day,
to check levels.
• Diet:
✓ Following a healthy diet and eating plan Eat regular meals and spread them evenly
throughout the day.
✓ Eat a balanced diet with a variety of foods, including fruits, vegetables, whole grain foods,
low-fat dairy products, and lean meat, poultry, fish or meat alternatives.
✓ Eat the right amount of carbohydrate foods for good blood sugar control. Your registered
dietician can determine how much carbohydrate food your body needs at each meal.
✓ Choose lower fat options and limit saturated fats.
✓ Use sugar in moderation. Consider lower sugar options if available.
✓ Check nutrition labels.
✓ Get your fiber. The American Dietetic Association recommends that all people eat 20-35
grams of fiber per day. Fruits, vegetables, beans and whole grain foods are good sources of
fiber.
✓ Drink plenty of water.
✓ Use less salt.
62
• Exercise: Taking regular exercise
• Foot Care: It is very important to check feet daily, keep clean and soft, wear well-fitting,
breathable shoes and socks
✓ Wash feet daily in lukewarm water.

✓ Dry them gently, especially between the toes.
✓ Moisturize your feet with lotion. Check your feet every day for blisters, cuts, sores,
redness or swelling
❖ Complications:
➢ Short-term Diabetes Complications
Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar)
The signs and symptoms of low blood glucose are usually easy to recognize:
• Rapid heartbeat
• Sweating
• Paleness of skin
• Anxiety
• Numbness in fingers, toes, and lips
• Sleepiness
• Confusion
• Headache
• Slurred speech
Diabetic Ketoacidosis: Diabetic ketoacidosis (sometimes abbreviated to DKA)
The signs and symptoms of DKA are:
• Frequent urination
• Extreme thirstiness
• Abdominal pain
• Weight loss
63
• Fruity smell on breath (that’s the smell of ketones being released from your body)
• Cold skin
• Confusion
• Weakness
➢ Long-term Diabetes Complications
These complications develop over many years—usually at least 10 years—and they all relate
to how blood glucose levels can affect blood vessels. Uncontrolled blood glucose can, over time,
damage the body’s tiny and large blood vessels.
Damage to your tiny blood vessels causes microvascular complications; damage to your
large vessels causes macro vascular complications.
✓ Microvascular Complications: Eye, Kidney, and Nerve Disease
Eyes: Because of type 1 diabetes, you can develop cataracts and/or retinopathy in your
eyes. Retinopathy, or damage to the retina.
Kidneys: If untreated, kidney disease (also called diabetic nephropathy) leads to dialysis and/or
kidney.
Nerves: Nerve damage caused by diabetes is also known as diabetic neuropathy.
✓ Macro vascular Complications: The Heart

Type 1-diabetes can also affect the large blood vessels, causing plaque to eventually build up and
potentially leading to a heart attack
64
65

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Mansoura University

Mode of transmission & Risk Factors

Clinical manifestation (Signs &Symptoms)

▪ Fever, cough, runny nose, sore throat

Physical examination and/ or Diagnostic measures

Management & Prevention

Risk Factors & Mode of transmission

▪ Age: More common in age group 5-15 years

Clinical manifestation (Signs &Symptoms)

Physical examination and/ or Diagnostic measures

1. Clinical manifestation (main diagnostic measures)

Management & Prevention

▪ Isolation& bed rest untill clinical manifestation subsides

Risk Factors & Mode of transmission

Clinical manifestation (Signs &Symptoms)

Prodromal stage (Pre-eruptive stage):

These symptoms occur 1 to 5 days before the rash appears.

Physical examination and/ or Diagnostic measures

Management & Prevention

Mode of transmission & Risk Factors

Prodromal stage (Pre-eruptive stage):

Once the chickenpox rash appears, it goes through three phases:

Physical examination and/ or Diagnostic measures

Risk Factors & Mode of transmission

Clinical manifestation (Signs &Symptoms)

Physical examination and/ or Diagnostic measures

▪ Covering your mouth when coughing or sneezing

Management (Control measures)

This can lead to:

▪ Valvular stenosis - the valve narrows, causing a drop in blood flow

An acute, highly infectious disease caused by a bacillus (Salmonella typhi), bacterial

Communicability period: The diseases are communicable as long as typhoid or

Contaminated water or food (transmitted by the faecal–oral route).

▪ Poor standards of hygiene in food preparation and handling

Risk factors or group

▪ People who ingest contaminated food.

Signs and symptoms

Once signs and symptoms do appear, you're likely to experience:

If you don't receive treatment, you may:

In addition, life-threatening complications often develop at this time.

Tests and diagnosis

 Medical and travel history

 Body fluid or tissue culture

• The Widal test.

▪ Antibiotics such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole,

The 2 most common complications in untreated typhoid fever are:

▪ The hepatitis A virus is transmitted primarily by the faecal-oral route.

Hepatitis A cannot get from:

• Being coughed or sneezed on by an infected person.

High Risk group

✓ Detection of HAV-specific immunoglobulin G (IgM) antibodies in the blood.

▪ There is no specific treatment for hepatitis A. Recovery from symptoms following

Life cycle (causative agent, diagnostic stage, infective stage)

People infected with Ascaris often show no symptoms.

If symptoms do occur they can be light and include

1. Infection occurs worldwide in warm and humid climates

Physical examination and/ or Diagnostic measures

Infective stage: Embryonated eggs

Diagnostic stage: eggs on perianal folds

Clinical manifestation (Signs & Symptoms)

• Frequent and strong itching of the anal area

• Pain, rash, or other skin irritation around the anus

• Presence of pinworms in the area of your child’s anus

• Presence of pinworms in stools.