MEASLES

MEASLES

Measles are also known as khasra and rubella which means red
spot. The disease is endemic in all parts of the world but in India,
it is spread more between January to April.
 Causative agent: (RNA) Paramyxovirus
 Susceptible host:
 Children between age group of 6 months to 3 years.
 Malnourished children are affected severely
 Incidence is equal in male and female children
 Environmental factors
 Low socioeconomic conditions
 Overcrowding residents
 Mode of transmission:
 Directcontact during the period of infectivity, i.e. 4 days
before appearance of rash and 5 days after rash appears
 Droplet infections as the virus is present in respiratory
secretions
 Droplet nuclei
 Portal of entry: Respiratory tract.
 Incubation period: 10-14 days
Clinical manifestations:
Pre-eruptive stage: Onset is abrupt and resembles the following.
 Severe cold.
 Moderate fever (102°F)
 Sneezing
 Watering of eyes and nose
 Eyes become red and sensitive to light
 Hoarseness of voice due to laryngitis
 Appearance of KOPLIK'S spot (small, white spots often on a reddened background) on
the mucus membrane of mouth and inner surface of lips seen opposite the lower
molar in good light.
Eruptive stage:
 On4th day, there is an increase in the severity of
symptoms.
 Bronchitis well marked
 Eye lids become puffy and swollen rash appears on
forehead, temples and behind the ears, face, trunk
and limbs as slightly raised dusky spots as macules.
 Eruption lasts for 3-4 days followed by straining of the
skin
 Temperature remains high for 1-2 days and then
gradually subsides in the absence of complications.
Management:
 Prevention: Active immunization by giving measles vaccine
0.5 ml subcutaneously at the age of 9 months or MMR vaccine.
 Passive immunization: Immunoglobulin 0.25 ml/Kg body
weight can be given during the incubation period, i.e., 3-4 days
of exposure to protect the child from disease.
Isolation: Child should be isolated for 7 days after the onset of
the rash notification of the disease.
Diagnosis are confirmed from the appearance of koplik's spot
and distribution and type of rash.
Treatment:
 Rest in bed
 Reduce fever by antipyretics
 Adequate fluids and feeds
 Antibiotics to prevent complication
 Care of the eyes
 Immunization at the beginning of an epidemic helps to
control the disease
 Disinfection:Proper disinfection of articles and linen
used by the child
Complications:
 Bronchitis
 Pneumonia
 Conjunctivitis
 Otitis media
 Encephalitis
 Febrile convulsions
 Diarrhea
It is an acute respiratory tract infection of short duration. This virus has 3 categories,
Type A , B and C. Influenza A and influenza B affect human. The infection is worldwide it
is an acute respiratory tract infection of short duration due to influenza virus.
Causative agent: influenza virus (A and B).
Mode of spread: Droplet infection , droplet nuclei and personal contact
Incubation period: 1-3 days
Portal of entry: Respiratory tract.
Clinical manifestations:
 Influenza starts with cold and cough
 Fever starts after 1-4 days of cold and cough and patient feels cold and chills.
 Body aches, dry cough, blockage of nose
 Running nose, headache, sore throat
 Generalized weaknesses, loss of appetite
Diagnosis:
 By clinical signs and symptoms
 By laboratory investigations, serological examination, virus is
detected by indirect fluorescent antibody technique.
Prevention: By giving influenza vaccine but the immunity is
short lived up to 6 months.
Control:
 To avoid overcrowding places.
 Good housing and ventilation.
 Covering face and nose while coughing and sneezing with
handkerchief
 Isolations of infected cases
Management:
 There is no specific treatment, only symptomatic treatment to protect from
complications
 Isolation and rest in bed in well-ventilated room
 To control fever by antipyretics
 To control cough and cold by giving steam inhalation and cough expectorant
 Antibiotics to prevent secondary infection, maintain adequate caloric requirement
and build up general resistance to infection
 Antiviral drugs like amantadine or rimantadine 100 mg BD for 3-5 days may be given
Complications:
 Pneumonia
 Bronchitis
 Pleurisy
MUMPS
MUMPS (INFECTIVE PAROTITIS)

Mumps are highly infectious disease which occurs due to viral

infections and causes inflammation of parotid glands.
Epidemiological factors: Disease occurs throughout the world.
The morbidity is high and mortality is negligible. It is found more
during winter and spring season.
Epidemiological triad:
 Causative agent RNA: Virus of myxovirus family
 Host: Common in children between host 5 and 15 years of age
but it also occurs in adults in severe forms. One time infection
produces life time immunity
 Environment: Winter, spring, overcrowding
 Mode of spread: Personal contact, droplet nuclei
Clinical manifestations:
 Swelling of one or both the parotid glands.
 Fever, pain over the swollen glands.
 Stiffness in opening mouth.
 Pain during mastication and swallowing fluids
 Bodyache and restlessness, may be earache on affected side
 Headache, swelling remains for a week, other symptoms may
disappear.
Clinical diagnosis:
 By signs and symptoms
 Palpating the swelling behind and below the ear
Prevention: By vaccinating children with combined vaccination
of MMR at the age of 9 months.
Control and management:
 Early diagnosis
 Isolation
 Disinfections of the fomites and secretions
 Notification
 Surveillance
Management includes:
 Rest in bed and isolation
 Treatment of fever
 Plenty of oral fluids, soft and nourishing diet
 Frequent mouth wash with antiseptic solutions
Complications: Otitis media, orchitis in male oophoritis in female, pancreatitis,
myocarditis, encephalitis
CHICKENPOX

It is an acute infectious disease which occur in epidemic and endemic throughout the
world.
Epidemiological triad:
Environment:
 Disease is more common in winter season and children are affected more than
adults.
 One attack produces immunity. Second attacks are very rare.
 Causative agent: Varicella zoster virus
 Environmental factors: Overcrowding, winter season
 Host factors: Children under the age of 10 years, adults are also affected
 Mode of transmission: Direct contact, droplet infection, droplet nuclei
Portal of entry: Respiratory tract
Incubation period: 7-21 days.
Clinical signs and symptoms: It varies from mild illness to severe illness. The clinical
course has two stages.
Pre - eruptive stage :
At the onset of the disease low to moderate fever accompanied by shivering and
malaise.
Backache, restlessness. This stage lasts for 24 hours.
Eruptive stage:
Rash starts appearing on the body with onset of fever, itching in the skin.
Rash appears symmetrically in the body. First on the trunk and then on the face, axilla,
arms and legs. Rash is more on the body, (Centripetal distribution)
Different stages of rashes are seen together, (macule, papule, vesicule and scabs. This
stage lasts for 4-7 days. Rashes do not occur on the palms and soles.
Diagnosis:
The characteristics of rashes, appearance of all stages together is
diagnostic in chickenpox.
Prevention: Varicella Zoster immunoglobulin can be given within
7 hours of exposure.
Control of chickenpox: It includes: isolation, notification, early
diagnosis, treatment is symptomatic, rest in bed, antipyretics to
reduce fever, antiseptic soothing lotions can be applied on the
skin, plenty of oral fluids and soft diet, disinfections of the articles
used for patient.
Complications: Complications are rare, but in certain cases it
may cause: Pneumonia, hemorrhages, encephalitis might, reye's
syndrome.
SMALLPOX
Smallpox is caused by variola virus, It is highly infectious and characterized by high
fever, headache, backache, vomiting and convulsions.
Appearance of rash in centrifugal distribution.
Incubation period: 12 days.
Signs and symptoms: Sudden onset of fever with headache, backache, vomiting.
Rashes appear on 3rd day of fever, and passes through successive stages of macule,
papule, vesicle, pustule, and scab.
Distribution of rash is centrifugal type.
On 8th may 1980, WHO declared that, the disease is eradicated totally from the world
and since 1982, all member nations of WHO stopped smallpox vaccination. India also a
smallpox free country.
DIPHTHERIA
DIPHTHERIA
It is an acute highly infectious disease caused by bacterial
infection. The bacteria remains in the throat and produce highly
poisonous exotoxins which affect the heart and nervous system.
Epidemiological triad:
Agent: Corynebacterum diphtheria
Host: 1-5 years age group
Env factors: Winter
Incubation period: 2-6 days
Mode of spread: Droplet nuclei, infected skin, lesion, fomites,
skin cuts and wounds.
Portal of entry: Respiratory route, cuts and wounds
Clinical features: Diphtheria affects ear, nose, and throat. Its types and characteristics are.
Pharyngo tonsillar diphtheria:
 Sore throat, difficulty in swallowing, restlessness and fever.
 A whitish membrane is found on the tonsils. This can be easily wiped off. Later it becomes thick
blue-white to gray and difficult to remove if tried and results in bleeding.
 Lymph glands around neck get swollen and give "bull neck appearance"
 Edema of submandibular area
 Mucosal edema around the membrane
Laryngotracheal diphtheria:
 Breathing difficulty, hoarseness of voice, severe irritating cough, infection may spread into the
respiratory tract and can cause serious conditions
Nasal diphtheria:
 Mucous and blood comes from nose.
 One side nostril may be blocked
 If membrane is formed, difficulty in inhaling occurs.
Diagnosis:
 Diagnosis is made from clinical signs and symptoms
 Examination of nose and throat and presence of
diphtherial membrane
 Laboratory test include examinations of nose and
throat secretions
 Shicktest is done to know whether the individual is
susceptible to corynebacterium diphtheriae toxins.
Control and prevention:
 Early detection, hospitalization and isolation
Management:
 Diphtheria antitoxins 10,000-80,000 units should be given IM or IV depending upon
the severity of the disease.
 Antibiotics injection sodium penicillin 2.5 lac QID for 5 days or injection erythromycin
250 mg QID
 In case of laryngotracheal diphtheria if respiratory stridor is present, tracheostomy
may be required
 Care of tracheostomy tube
Complications:
 Pneumonia
 Nephritis
 Laryngitis
 Myocarditis
 Peripheral neuritis
POLIOMYELITIS

Poliomyelitis is a highly infectious disease caused by polio virus. the disease affects the
nervous tissue causes paralysis and deformities
Epidemiological factors:
 Causative organisms is polio virus I, II and III
 It attacks children below the age of 5 years
 Infection is more in unhygienic places, overcrowding and dirty places where personal
hygiene is neglected
 Polio is more common during rainy season
Source of infection: Contaminated water, food, milk.
Mode of spread: Orofecal route, flies play an important role in spreading infection as
virus remains in stool of infected person for three months
Incubation period: 7-14 days
Clinical signs and symptoms:
 Fever, headache, vomiting, diarrhea, fatigue, cough,
and cold.
 Muscular weakeness
 Stiffness in the back and neck are the warning signs of
paralysis. Paralysis may occur in legs, face, larynx and
esophagus.
 Paralysiscommon of lower parts of body patient
becomes permanently handicapped
Diagnosis made from signs and symptoms.
Complications: Paralysis and permanent deformity, if
respiratory muscles involved death may occur.
Management:
 No specific treatment
 Symptomatic care
 Physiotherapy of the affected limbs to minimize deformity
 Disinfection of the secretions and articles used for patient
Prevention and control:
 Notification of cases
 Active immunization with polio vaccines
 With the pulse polio program India is about to reach at its
target of eradication of polio
WHOOPING COUGH ( PERTUSSIS )

Whooping cough is highly infectious disease of children. The cough produces long noisy
inspiration which ends in a special voice called whoop.
One attack produces sufficient immunity.
Because of the awareness of vaccination the attack of this disease has reduced
remarkably and mortality has reduced.
Causative agent: Bordetella pertussis bacilli.
The susceptible host: Infants and children under the age of two years who are not
vaccinated are affected.
Environmental factors: Winter season, spring season and overcrowding favors the
disease.
Mode of spread: Droplet infection, droplet nuclei and direct contact
Inoculation period: 7-14 days
Clinical manifestations: Whooping cough has three stages:
 First or catarrhal stage: This stage is accompanied by:
 Sneezing, watering from eyes and nose, mild fever
 Loss of appetite, hacking and nocturnal cough.
 This stage lasts for 10 days
 Second and paroxysmal stage:
 Bouts of cough occurs and each bout ends in a specific
inspirational noise resembling kho kho.
 Because of mucus blockage, vomiting may occur.
 Child's face becomes red during the bout.
 This stage lasts for 2-3 weeks.
 Third or convalescent stage:
 Bouts of cough and vomiting becomes less but the ordinary respiratory infection can bring
about attacks of cough
Diagnosis: Diagnosis are made with typical types of cough. Throat and nasal swabs
and sputum for culture and ABST can show the growth of B pertussis.
Control and management: Whooping cough can be controlled by active
immunization with DPT vaccination.
Management includes:
 Admission in the hospital
 Isolation
 Antibiotics to control infection
 Cough syrup, antipyretic syrup
 Oxygen therapy if indicated
 Plenty of oral fluids and nourishing diet
 Disinfection of secretion and fomites
Complications:
 Pneumonia
 Bronchitis
 Encephalitis
 Hernia
 Bleeding from eyes and nose
TETANUS
TETANUS is an acute infectious disease. It is more common in developing countries.
Tetanus occurring in new born is known as tetanus neonatrum.
Epidemiological factors:
Causative agent:
 It is an aerobic spore forming bacteria clostridium tetani.
 The disease is transmitted when cuts, wounds, surgical incision, and burns come in
contact with contaminated material
 Soil, dust, cow dung and dirt are the source of infection
 Tetanus occurs in unvaccinated individuals
 Newborns and infants infected with tetanus have higher mortality rate
 Rural population is affected more than urban
 Infection spreads in more unhygienic environment and when aseptic precautions are
not taken during delivery.
Inculcation period: 3-21 days.
Mode of spread: open wound with contaminated material
Clinical manifestations: The exotoxins produced by the clostridium tetani enter the
blood circulation and lymphatic system and affect the central nervous system and
produce the following symptoms:
 Fever, tachycardia, restlessness, sweating, spasm of muscles and irritability
 Difficulty in opening the mouth (lock jaw).
 Particular type of facial appearance known as sardonic smile.
 Bowing of the back (opisthotonos)
 Repeated convulsions
 Involuntary contraction of muscles, severe pain
 Immediate death may occur if there is spasm of respiratory muscles
SARDONIC SMILE AND
OPISTHOTONOS
Diagnosis: History of injury and from the signs and symptoms.
Complications:
 Pneumonia
 Atelectasis, respiratory emboli
 Severe stomach ulcer
 Arrhythmia
 Death may occur if proper treatment is not implemented
Control measures: TT vaccination
Management:
 Hospital admission, isolation.
 Tetanus antitoxins to neutralize the bacterial toxin
 Muscle relaxant to control spasm.
 Sedatives and anticonvulsant drugs
 Care of open wound, antibiotics, general care of patient, nutrition to be maintained,
proper disinfection of all soiled linen and equipment
TUBERCULOSIS
Epidemiological factors:
 Tuberculosis is an infectious disease and affects all age groups, both sexes, rich and
poor, rural and urban. Dr Robert Koch first discovered tuberculosis bacilli which cause
the disease.
 India accounts for 1/3rd of total global TB burden with 1.8 million dying due to TB
every year.
 Tuberculosis affects women more in reproductive age group and it is estimated 1/3 of
the total infertility of female in India is caused by Tuberculosis.
 The most affected age group is 15-54 year which is economically productive age 70%
of TB cases occur in low socioeconomic group due to poverty, illiteracy, crowded
environment and lack of personal hygiene.
 Tuberculosis is one of the six killer diseases.
 Tuberculosis of animals is known as bovine tuberculosis.
 People suffering from HIV infection are more prone to set Tuberculosis.
Epidemiological triad:
 The causative agent is agent mycobacterium
tuberculosis.
 Environment: Overcrowding, poor housing, illiteracy,
low socio economic, status, poor personal hygiene.
 Host:Malnourished individuals, low immunity, all age
groups, malnourished and person suffering from HIV /
AIDs are more prone to the disease.
Incubation period: 4-8 weeks.
Mode of spread: Droplet infection and droplet nuclei,
direct contact.
Portal of entry: Respiratory tract
Clinical manifestations:
 Low grade fever which increases in the evening
 Loss of weight
 Loss of appetite
 Sweating at night
 Cough for 3 weeks or more
 Fatigue and general weakness
 Chest pain, breathing difficulty and blood with sputum
(hemoptysis) may be coughed out
 Enlargement of lymph nodes
Miliary TB:
Can affect lymph glands, brain, bones, joints, kidneys and intestine.
Clinical findings:
 Weight loss
 Fever
 Night sweats
 Swelling of the glands, joints pain in the affected area
 Enlargement of glands
Diagnosis:
 From clinical signs and symptoms
 Microscopic examinations of sputum for acid fast bacilli
 Chest X-ray
 Tuberculin test and FNAC
 Tissue biopsy
Complications:
 Physical disability
 Danger of AID attack
 Death

Prevention and control:

 Early diagnosis:
 Sputum examination
 Radiography

 Tuberculin test
Prevention: Case finding, active immunization by
bacillus Calmette-guérin
Treatment of detected cases:
Chemotherapy includes:
 Antitubercular drugs
 First line drugs
 Second line drugs
 First line drugs are:
 Bacteriocidal - isonex, rifampicin, streptomycin, and
pyrazinamide
 Bacteriostatic – ethambutol, thiacetazone
R: RIFAMPICIN
I: ISONIAZIDE
P: PYRAZINAMIDE
E: ETHAMBUTOL
S: STREPTOMYCIN
First line treatment: given 1-3 months .
 Tab rifampicin 10-12 mg/kg body weight given in empty
stomach for better absorption. Side effects gastritis,
hepatotoxicity, nephrotoxicity and thrombocytopenia.
 INH (isonex) 4-5 mg / kg body weight. Maximum dose 300
mg/OD.
 Side effects of isonex: Peripheral neuritis, gastritis, intestinal disturbance,
hepatitis
 Tab pyridoxine (vit B6) 10-20 mg given once a day to prevent
peripheral neuritis
 Injection streptomycin: Dose 0.75-1 g once a day
intramuscularly.
 Side effect: It is toxic to VIII cranial nerve and causes deafness, giddiness
and ataxia
 Note: If the patient complains of ringing in the ears, injection
Bacteriostatic drugs: These are given during
continuation phase after intensive phase. These
are given for 4-6 months after bactericidal
combination of 2 or 3 drugs given.
 Tabethambutol 15 mg/kg body weight (800
mg/day) in divided doses
 Side effects : blurring of vision, retrobulbar neuritis.
 Thiacetazone: Dose 2 mg/kg body weight (150
mg/day)
 Side effects: GIT disturbances, glaring of vision
Second line drugs: These are used when the first line
drugs are not responding or cannot be used for some
reasons.
This include ethionamide, prothionamide, cycloserine,
kanamycin, viomycin, ofloxacin, capreomycin
H- ISONIAZID
R- RIFAMPICIN
Z- PYRAZINAMIDE
E- ETHAMBUTOL
CATEGORY 1

TYPES OF PATIENT TREATMENT REGIMEN

NEW SPUTUM SMEAR 2H3R3Z3E3 + 4H3R3
POSITIVE Prefix is month.
SERIOUSLY ILL, NEW Suffix is administration in a
SPUTUM SMEAR NEGATIVE week.
SERIOUSLY ILL, NEW EXTRA
PULMONARY
CATEGORY 2

TYPES OF PATIENT TREATMENT REGIMEN

SPUTUM SMEAR POSITIVE 2H3R3Z3E3 + 1H3R3E3 +
RELAPSE 5H3R3E3
SPUTUM SMEAR POSITIVE Prefix is month.
FAILURE Suffix is administration in a
week.
SPUTUM SMEAR POSITIVE
TREATMENT AFTER DEFAULT
IF SPUTUM SMEAR IS POSITIVE
AT THE END OF THE INTENSIVE
PHASE ADDITIONAL MONTH OF
INTENSIVE TREATMENT TO BE
GIVEN
CATEGORY 3

TYPES OF PATIENT TREATMENT REGIMEN

NEW SPUTUM SMEAR 2H3R3Z3 + 4H3R3
NEGATIVE Prefix is month.
NOT SERIOUSLY ILL Suffix is administration in a
NEW EXTRA week.
PULMONARY
MENINGOCOCCAL MENINGITIS

 Meningococcal meningitis is a bacterial infection of

meningeal layers of the brain and spinal cord. It occurs
in sporadic form in small outbreaks in most parts of
the world.
 About 10-20 % of the people carry Neisseria
meningitidis in there, throat.
 Mortality rate is 5-10%.
EPIDEIOLOGICAL TRIAD:
 Agent: Neisseria meningitides
 Host: Children and young adults
 Environment: Overcrowding dry and cold months of
the year
Mode of transmission: From person to person through droplets
and throat secretions
Portal of entry: Nasopharynx of respiratory system.
Incubation period: 2-10 days
Signs and symptoms:
 Fever ranging from 103-105F
 Tachycardia
 Stiffness of neck
 Headache
 Vomiting
 Sensitivity to light
Diagnosis:
 Examination of cerebrospinal fluid
 Positive kernig's sign
 Blood culture
 Clinical signs and symptoms of the disease
Prevention and control:
 Isolation
 Early diagnosis
Treatment:
 The drug of choice is penicillin for carriers.
 Chloramphenicol is the alternative drug for cases who are sensitive to penicillin.
 For contacts, sulfadiazine 1 g BID for 2 days those who are sensitive to sulfadiazine
rifampicin 600 mg BD is given for 3 days.
 Symptomatic treatment for fever.
 Patient to be nursed in semi dark room
 Care of the eyes
 In acute stage usually the patients are semiconscious, nasogastric feeds are given
taking care of caloric requirement and nutrients.
 General care of the patient
 Disinfection of the infected material.
Mass treatment: It should be done under close
medical supervision. It causes immediate drop in the
incidence rate of cases and in poportion to carriers.
Immunization: Meningococcal polysaccharide vaccines
prepared from purified group A, C, group A C and Y,
group A, C, Y and W, Help to control the disease. It
should not be given to children under 2 years and
infants.
Environmental sanitation
Complications:
 Brain damage
 Hearing loss
 Meningococcal septicemia
 Learning disability
 Hemorrhagic rash
 Circulatory collapse
DENGUE

Dengue infection is caused by dengue virus

which is spread in human beings by the mosquito
aedes aegypti and aedes albopictus.
 Causative agents: dengue virus
 Susceptible host: all ages and both sexes
 Environment: overcrowding, poor housing,
mosquitoes breeding
 Incubation period:- 4-6 days
Clinical manifestations:
Dengue infection occurs in three forms:
1. Dengue fever:
 High grade fever
 Weakness, fatigue, pain at the back of eyes
 Severe pain in forehead
 Loss of appetite, nausea, vomiting
 Pain in the muscles and joints
 Small rashes may appear on chest and arms
2. Dengue hemorrhagic fever:
 High fever which is continuous and it may
continue for 2-7 days
 Purpura,
epistaxis, hematemesis and melena
may occur
 Thrombocytopenia platelet count may fall
below 50,000/cmm.
 Hemoconcentration, hemoglobin level may
increase 20% above the normal
3. Dengue shock syndrome:
 Allsigns and symptoms of dengue fever and
dengue hemorrhage
 Bradycardia
 BP falls by 20 mm Hg
 Cold skin
 Confusion and imbalanced mind
Diagnosis:
 Physical examination and noting the clinical signs and
symptoms
 Serological test
 Platelet count
Management:
 Complete bed rest
 Antipyretics to reduce fever
 Hydrotherapy
 Plenty of oral fluids, if vomiting is there IV fluids
 Blood transfusion if platelet count is abnormally low
 General care of the patient
Control and prevention:
 Early diagnosis and management
 Notification
 Control of mosquitoes and their breeding places
 Health education of the people.
Immunity:
 No vaccine has been developed.
 Single attack of dengue produces resistence.