FWBD CASE

MANAGEMENT

HANSEL V. AMOGUIS, MD
FWBD- PROGRAM MANAGER

Antemelania asperata (78.3 mm)

This section provides the guide on:
▶ Detecting diarrhea case
▶ Assessing the dehydration level
▶ Management of cases
▶ Preventive measures
▶ The Clinical Practice Guideline is the main reference of
this section. This section provides a guide to health worker
(in the community or facility) on the actions (assessing,
treating or referring) upon finding the diarrhea case
 DETECTING DIARRHEA CASE

▶ The most common symptom of food and water-borne

diseases is diarrhea.
▶ The most threatening consequence of diarrhea is
dehydration
▶ may be detected in the community/facility by a barangay
health worker (BHW).
▶ Consider: when it started, char of the stool, pts physical
condition, level of dehydration
ASSESSMENT OF DEHYDRATION

▶ assess the level of dehydration of the patient as part of the

physical examination.
▶ the clinical manifestations of dehydration for children is
different from adults (general condition and tears).
MANAGEMENT OF DIARRHEA
CASE

▶ Fluid Replacement Therapy

▶ Anti-microbials and Other Adjunctive Therapy
▶ Preventive Measures
PREVENTIVE MEASURES
▶ Personal hygiene
▶ Safe /clean water
▶ Proper food handling
▶ Vaccination
▶ Health promotion activities
▶ A food-borne illness, occurs when a person
consumes contaminated food,

▶ Water-borne illness is caused by contaminated

water.

▶ In both cases, contaminants are usually micro-

organisms—bacteria (e.g. Salmonella ), parasites
(e.g. Cryptosporidium) or viruses (e.g. noroviruses,
Rotavirus)

▶ —but may also be chemical or physical

▶ Not everyone exposed to a food- or water-
borne pathogen will become sick.
▶ Many will have no symptoms and no
consequences to their overall health
▶ As a result, most people do not seek
medical treatment and the number of
reported cases are under-represented.
▶ Most vulnerable—the very young, the elderly,
pregnant women and those with chronic diseases or
weakened immune systems—may have more severe
symptoms and even die
FACTORS THAT CONTRIBUTE TO
WATER-BORNE ILLNESS OUTBREAKS

▶ lack of source water protection;

▶ contamination from weather events such as heavy
precipitation and spring thaw;
▶ inadequacy or failure of water treatment;
▶ failure of water distribution systems;
▶ other factors such as ongoing maintenance work
(including repairs and replacements) and human error.
▶ One of the difficulties of identifying the source of
sporadic or outbreak related water-borne illnesses
is that many of the pathogens spread by water
are also spread by food, animals and person-
to-person.

▶ Providing safe drinking water requires an

understanding of the drinking water supply and
associated infrastructure, including identifying
potential threats to water quality.
FOODBORNE DISEASES

DISEASES TRANSMITTED THROUGH

EATING FRESH OR PARTIALLY COOKED
MEAT, FISH, CRAYFISH, OR SNAIL
CONTAINING THE PARASITES

Antemelania asperata (78.3 mm)

 TAENIASIS

TAENIASIS (Tapeworm) transmitted through fresh or

partially cooked pork/beef meat containing the parasite
Tapeworm

Adult tapeworm from patient M.S. 36/M

in Brgy. Lambajon, Baganga, Davao
Oriental
Source: CDC-
DPDx
TAENIASIS

• Taenia solium
Taenia saginata
Taenia saginata
asiatica
◻ Mode of infection: ingestion
of pork, beef,or goat meat
infected with cysticercus
(larvae)
• Symptoms include
passage of worm
segments in the stool,
epigastric
pain/discomfort, and
pruritus ani
 CAPILLARIASIS

Transmitted through eating fresh or partially cooked fresh

water fish containing the parasite
▶ Capillaria philippinensis
▶ Mode of infection:
consumption of raw or
insufficiently cooked
freshwater fishes
containing larvae
▶ Symptoms include chronic
diarrhea, abdominal pain,
and borborygmi
Capillaria philippinensis :
CLINICAL MANIFESTATIONS AND PATHOLOGY

• Gurgling stomach
• Diarrhea
• Anorexia
• Abdominal pain
• Weight loss
• Malaise
• Vomiting
• Bi-pedal edema
 PARAGONIMIASIS

Disease transmitted through consumption of fresh or

partially cooked fresh water crab/crayfish with parasites

Freshwater crab retrieved from a river

along Brgy. Aragon, Cateel, Davao
Oriental
Paragonimiasis
Paragonimus westermani

• Lung fluke

• Eggs from flukes in lungs are

passed with sputum or swallowed
and passed in feces.

• Snail as 1st intermediate hosts www.dpd.cdc.gov/.../body_Paragonimiasi

s_il1.htm

• Crustaceans (crabs) as 2nd

intermediate host

• Pulmonary paragonimiasis has

been described among patients
diagnosed to have PTB and not
responding to treatment .

Sundathelphusa philippina
TREATMENT

Praziquantel - 600 mg
tablet
(from DOH)
WATERBORNE DISEASES
Transmitted through ingestion of contaminated
water

Vibrio cholera
CHOLERA

⮚ Is an infectious disease acquired through ingestion of

contaminated food or water by V. cholera and causes
severe acute watery diarrhea transmitted fecal-oral route
⮚ Explosive onset of diarrhea which could be fatal in a short
period of time
⮚ Rapid loss of fluids and electrolytes causes hypoglycemia,
metabolic acidosis, acute renal failure and death in 48
hours
⮚ 1.3-4M cholera cases and 21,000-143,000 deaths annually
⮚ In urban-poor areas (no access to safe water and
sanitation)
MEMORANDUM FROM OFFICE
OF THE SECRETARY-DOH
DATED MAY 23, 2014

Interim Guidelines on the

Prevention and Treatment of
Cholera Infections
CHOLERA
⮚ DIAGNOSIS
⮚ Clinical presentation is that of voluminous, rapidly dehydrating
diarrhea of sudden onset which could be fatal in as short as 48 hours
after onset
⮚ Rapid Cholera Dipstick Test
⮚ Dark Field Microscopy
⮚ Request for a Rectal Swab for Stool Culture
⮚ Most common cause of Philippine outbreaks is serogroup 01, Ogawa
biotype El Tor
MANAGEMENT

Management of Dehydration:
(Rehydration- mainstay of treatment)
1. Assessment of Dehydration
2. Degree of dehydration and fluid deficit

A. Preparation of Oral Rehydration Salt:

½ level teaspoon salt + 6 level teaspoon sugar
Into 1 Liter of safe water
B. Zinc Supplementation

C. Antibiotics

D. Vitamin A

E. Dietary Management in Children

F. Others
▶ Oral Cholera Vaccines
TYPHOID FEVER
 Typhoid---ancient Greek Typhos,
smoke or cloud that was believed to
cause disease or madness
WHAT IS TYPHOID FEVER?

▶ Result of systemic infection caused by S. typhi.

▶ Clinically characterized by typical continuous fever for 3 to 4
weeks, relatively bradycardia with involvement of intestinal
lymphoid tissues, reticulo-endothelial system & gall bladder.
▶ “Enteric fever” includes both typhoid and paratyphoid fever.
▶ May occur sporadically, epidemically or endemically. Found
only in human.
WHO Estimates:
▶Infects roughly 21.6 million people each
year
▶ Kills 216,000-600,000 people each year
▶ 62% of these occurring in Asia and 35%
in Africa
INCUBATION PERIOD

Usually 10-14 days but it may be as short as

3 days or as long as 21 days depending
upon the dose of the bacilli ingested.
 Color pink therefore
Gram-negative

With peritrichous
flagella
RESERVOIR OF INFECTION
-human is the only reservoir
1. CASES
▶ A case is infectious as long as
bacilli appears in stools or urine.
▶ Case may be mild or severe.
2. CARRIERS
▶ Temporary/incubatory- excrete
bacilli for 6 to 8 weeks
▶ Chronic- excrete bacilli for more
than a year, organism persist in
gall bladder/biliary tract.
e.g. “Typhoid Marry” real name
Mary Mallon
SOURCE OF INFECTION

PRIMARY SOURCES
▶ Feces & urine of cases and SECONDARY SOURCES
carriers. ▶ Contaminated
▶ Water
▶ Fecal carriers are more frequent ▶ Food
than urinary carriers.
▶ Fingers
▶ Flies
Ingestion of contaminated food or water

Salmonella bacteria

Invade small intestine and enter the bloodstream

Carried by white blood cells in the liver, spleen, and bone marrow

Multiply and reenter the bloodstream

Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel
and multiply in high numbers

Then pass into the intestinal tract and can be identified for diagnosis in cultures
from the stool tested in the laboratory
ENVIRONMENTAL & SOCIAL FACTORS

❑ Typhoid fever regarded as “Index of general sanitation” in any

country.
❑ Outside human body bacilli found in-
water- 2 to 7 days but not multiply
soil irrigated with sewage- 35 to 70 days
ice & icecream- over a month
food- multiply & survive for sometime
milk- grow rapidly without altering its taste
❑ Pollution of drinking water supplies.
❑ Open area defecation & urination.
❑ Low personal hygiene.
❑ Health ignorance.
 MODE OF TRANSMISSION
The disease is transmitted by “faeco-oral route” or “urine–oral
routes” either directly through hands soiled with faeces or urine of
cases or carriers or indirectly by ingestion of contaminated water,
milk, food, or through flies. Contaminated ice, ice-creams, and
milk products are a rich source of infection.

water

Faeces and
soil Mouth of
urine from Foods raw
well
cases or or cooked
persons
carriers flies

fingers
 SIGNS & SYMPTOMS

Aches and
High fever
pains

Rose spots

Chest
Diarrhoea congestion Typhoid
Meningitis
 Rose spots
Pink papule 2-3mm on trunk, fade on pressure
Disappears in 3-4 days
GENERAL COMPLICATIONS
 Ileum e
special
ly dista
l ileum
jejunum ,
usually
not per does
usually forate i
happen n typho
s in the id,
third w
eek
MANAGEMENT OF TYPHOID FEVER:

▶ General: Supportive care includes

Maintenance of adequate hydration.
Antipyretics.
Appropriate nutrition.
▶ Specific: Antimicrobial therapy is the mainstay
treatment.
▶ Chloramphenicol, Ampicillin, Amoxicillin,
Trimethoprim & Sulphamethoxazole,
Fluroquinolones
▶ In case of quinolone resistance – Azithromycin,
3rd generation cephalosporins (ceftriaxone)
 CONTROL OF
TYPHOID FEVER

1. Control of reservoirs-
cases & carriers

2. Control of sanitation

3. immunization
VIRAL HEPATITIS
VIRAL HEPATITIS
HISTORICAL PERSPECTIVE

Enterically
“Infectious” A E transmitted

Viral “NANB”
hepatitis C
Parenterally
“Serum” B D transmitted
other
 HEPATITIS A VIRUS

▶ RNA Picornavirus

∙ Single serotype worldwide

∙ Acute disease and asymptomatic infection
▶ No chronic infection

∙ Protective antibodies develop in response to

infection - confers lifelong immunity
 HEPATITIS A - CLINICAL
FEATURES
•Jaundice by <6 yrs
<10%
age group: 6-14 yrs 40%-50%
>14 yrs 70%-80%
•Rare complications: Fulminant hepatitis
Cholestatic hepatitis

Relapsing hepatitis
•Incubation period: Average 30 days
Range 15-50 days
•Chronic sequelae: None
EVENTS IN HEPATITIS A VIRUS INFECTION
Clinical illness

Infectio ALT
n
Ig Ig
Response

Viremia M G

HAV in stool

0 1 2 3 4 5 6 7 8 9 10 11 12 13
Week
 CONCENTRATION OF HEPATITIS A VIRUS
IN VARIOUS BODY FLUIDS
Feces
Body Fluids

Serum

Saliva

Urine

100 102 104 106 108 1010

Infectious Doses per

Source: Viral Hepatitis and Liver Disease mL
1984;9-
22
J Infect Dis 1989;160:887-890
HEPATITIS A VIRUS TRANSMISSION

●Close personal contact

(e.g., household contact, sex contact, child
day-care centers)

●Contaminated food, water

(e.g., infected food handlers)

●Blood exposure (rare)

(e.g., injection drug use, rarely by transfusion)
PREVENTING HEPATITIS A

● Hygiene (e.g., hand washing)

● Sanitation (e.g., clean water sources)
● Hepatitis A vaccine (pre-exposure)
● Immune globulin (pre- and post-exposure)
 Prevention
•Drink only bottled or boiled water, or carbonated drinks
in cans or bottles.
(Fountain drinks and any drinks with ice cubes are not
safe

•Avoid fresh fruits or vegetables that were peeled by

someone else.

•Avoid milk, cheese or dairy products that may not have

been pasteurized.

•Avoid anything sold by street vendors.

FOOD SAFETY
▶ Drink clean water

MGA ANGAY BUHATON ARON

MALIKAYAN ANG SAKIT
▶ Wash hands with soap and water before
eating and after use of toilet

MGA ANGAY BUHATON ARON

MALIKAYAN ANG SAKIT
DAGHANG SALAMAT….