Communicable Disease
❖ Definition of Communicable Disease
➢ Communicable Disease is one that can transmitted from one person to another and is caused by an infectious agent that is transmitted from a source or reservoir to a susceptible host.
❖ Type of Communicable Disease
1. Vector Born Disease
2. Infectious Disease
3. Zoonotic Disease 1. Vector Born Disease
❖ Malaria
➢ Malaria is a common public health problem in India
➢ Malaria is caused by parasites disease
➢ It is caused by plasmodium and transmitted by infected female anopheles mosquito
Types of Malaria
1. Plasmodium Vivax- 70% 2. Plasmodium Falciparum- 25 to 30% 3. Plasmodium Malariae- 1% 4. Plasmodium Ovale- very rare case
➢ Most common cause of malaria in India by plasmodium vivax
➢ Plasmodium falciparum is also known as Cerebral Malaria/ Black water fever
➢ Plasmodium falciparum has a higher mortality than plasmodium Vivax Incubation period
➢ Plasmodium vivax- 8-17 days (14 day)
➢ Plasmodium falciparum - 9 to 14 days (12 day)
➢ Plasmodium malariae- 14 - 40 days (28 day)
➢ Plasmodium ovale - 16 to 18 days (17 day)
Clinical symptom
- Three stage1. Cold stage- headache, nausea, vomiting and chills with fever every 3rd or 4th day 2. Hot stage- body temperature is very hot 3. Sweating stage- the temperature drop down to normal with profuse sweating
➢ Other symptom- jaundice and anemia etc
Diagnosis test
➢ Microscopy test
➢ Rapid malaria test
Prevention
➢ National malaria control programme (NMCP) – 1953
➢ National malaria eradications programme in - 1958
➢ National vector borne Disease Control programme (NVBDCP) - 2015
Treatment of plasmodium vivax
➢ Chloroquine phosphate की 500mg each table मेंChloroquine base - 300mg होता हेइस आधार पर dose दिया जाता हे Day-1 Day – 2 Day - 3 Chloroquine base -10/kg Chloroquine base -10/kg Chloroquine base - 5/kg 300mg +300mg 600mg 300mg Avg wt- 60kg Avg wt- 60kg Avg wt- 60kg Tab - primaquine - 15mg x 14day
➢ Contraindication of primaquine – pregnancy - Infant child - G6PD enzyme deficiency
➢ This drug haemolysis in the body so cause by jaundice and anaemia etc
Treatment of plasmodium falciparum
➢ Artemisinin based combination therapy (ACT)
➢ Artesunate + sulfadoxime + pyrimethamine Day-1 Day – 2 Day - 3 Artesunate 200mg Artesunate 200mg Artesunate 200mg + + sulfadoxime 1500mg Primaquine - 45mg + pyrimethamine 75mg
➢ Artesunate+ lumefantrine + primaquine Day-1 Day – 2 Day - 3 Artesunate 80 mg Artesunate 80 mg Artesunate 80 mg + + + lumefantrine 480 mg lumefantrine 480 mg lumefantrine 480 mg BD BD BD + single dose - primaquine -45mg
Treatment of Severe malaria
➢ Injection Arteether 150 mg IM once daily for 3 days
➢ Quinine sulfate injection IV drip in 5% dextrose saline
➢ Quinine sulfate cause hypoglycemia
➢ Chloroquine phosphate tablet safe in pregnancy
➢ Quinine safe in the only first trimester of pregnancy
➢ primaquine is Contraindication in pregnancy
❖ Filaria
➢ Lymphatic filariasis commonly known as filaria is caused by 3 nematode parasites Parasites Vector mosquitoes Wuchereria bancrofti (वुचेरे ररया बैनक्रॉफ्टी) Culex (क्यूलेक्स) Brugia malayi (ब्रुगिया मलयी) Mansonia (मैनसोगनया) Brugia timori (ब्रुगिया गिमोरी) Mansonia (मैनसोगनया)
➢ Only wuchereria bancrofti (वुचेरेररया बैनक्रॉफ्टी) and brugia malayi (ब्रुदिया मलयी) found in India
➢ Wucheria bancrofti (वुचेरे ररया बैनक्रॉफ्टी) spread by culex mosquito 99.4% of fileriasis in India
➢ This parasities are transmitted to human through the bite of infected mosquito and developed into the adult worms in the lymphatic vessels causing severe damage and swelling lymph node (lymphoedema)
Clinical symptom and type
1. Lymphatic filariasis (लसीका फाइलेररया) -Lymphangitis -Lymphoedema -Hydrocele or Elephantiasis Swelling in scrotum Swelling in limbs Blockage of Lymph vessels
2. Occult filariasis (ऑकल्ट्फाइलेररया)
➢ Classical manifestation are not present
➢ Microfilariae (माइक्रोफाइलेररया) are not found in the blood at day
➢ Blood collection should be done at night in occult filariasis (ऑकल्ट्फाइलेररया)
Diagnosis test
➢ Blood sample at night ➢ Sensitive test
➢ Immunochromatographic card test (ICT)
Management
➢ Do not give anti-filerial drug
➢ Give the antipyretic drug
➢ Give analgesic drug
➢ Give Oral antibiotic drug- amoxicillin, erythromycin
➢ Clean the limb with antiseptic
➢ Drug Of Choice Is Diethylcarbamazine
➢ Hydrocele management - if necessary surgery
❖ Kala Azar
➢ Kala-azar is a parasitic disease caused by leishmania (लीशमैदनया) transmitted by the bite of infected female phlebotomine argentipes (मािा फ़्लेबोोमाइन अजेाइपस) (Sand Fly) (काला – साांड)
➢ Is also known as leishmaniasis (लीशमदनयादसस
➢ Rural area ➢ Heavy rainfall
➢ Humidity (नमी) above 70%
➢ Temperature range of 15 to 38 degree Celsius
➢ Kala Azar is endemic in 54 district in the country including Bihar, Jharkhand and West Bengal and Uttar Pradesh
➢ The state of Bihar alone contribute to more than 70% of total kala Azar (लालूऔर कालू- दबहार मेंkala-Azar)
Clinical symptom
➢ Fever ➢ Splenomegaly
➢ Hepatomegaly
➢ Anaemia
➢ Weight loss
➢ Lymphadenopathy
➢ Dark of skin, face, hand, foot and abdomen
Diagnosis test
➢ Blood examination
Primary management and referral
➢ First line drug - Sodium stibogluconate 20mg/kg by single injection IM for 20-30 days
➢ Second line drug- Amphotericin -B 1mg/kg on alternate day for 15- 20 days
❖ Japanese Encephalitis (JE)
➢ JE cause by viral encephalitis in Asia
➢ JE transmitted by culex mosquito
➢ Highest risk of rural area
➢ JE does not in urban area
➢ JE transmission during rainy season
➢ Domestic pigs (सुअर) and wild birds (जांिली पक्षी) are reservoir of the virus
➢ Incubation period 5 - 15 day
Clinical symptom
➢ Primary effect centre nervous system
➢ Encephalitis
➢ Headache
➢ Meningitis
➢ Fever
➢ Disorientation
➢ Coma
➢ Paralysis
➢ Mental retardation
Diagnosis test
➢ Physical and mental examination
➢ Blood test Primary management and referral
➢ There is no specific anti-virus medicines or treatment against JE virus
➢ It's only symptomatic management
➢ It seen danger sign like lethargy, unconsciousness, conversion, paralysis etc
Refer to CHC Treatment on CHC IV line fluid, Suction, O2 therapy, Catheterization, Injection –PCM, Assess the Vital sign, Maintain input output chart More severe danger sign Refer to tertiary hospital
❖ Dengue
➢ Dengue is viral infection transmitted by female Aedes aegypti mosquitoes
➢ Peak month- September to October
➢ Human are the main carriers and multiplier of the virus
➢ Present in urban area and in proper water dispose management and domestic water storage specific tank etc
➢ Mosquito peak biting period at early morning and evening before night
Type and Clinical symptom and diagnosis
1. Dengue fever ( classical dengue or break bone fever)
➢ Incubation period - 4 to 10 days
➢ High fever
➢ Headache
➢ Pain in eye
➢ Nausea and vomiting
➢ Rash
➢ Joint bone muscles pain
2. Dengue haemorrhagic fever
➢ Spontaneous bleeding
➢ weak low BP
➢ Hypertension
➢ Restlessness
➢ Incubation period - 4 to 6 day
➢ Diagnosis test -Platelet count
3. Dengue shock syndrome
➢ Severe condition of dengue
➢ It occur duration - 12 to 24 hours
➢ Systolic blood pressure fall
➢ Metabolic acidosis
➢ Multiple organ failure
➢ Hypovolemic shock
➢ Pleural effusion
➢ Ascities
➢ Hypothermia
➢ Cold skin
➢ Liver failure
Diagnosis test
➢ Platelet count confirmation test
Primary management and referral
➢ Fluid intake oral or iv
➢ Antipyretic drug – PCM
➢ NSAID drug
➢ Avoid Aspirin drug
➢ Platelet transfusion are below 10000 /cu.mm but the patient should not be discharge the platelet are more than 50000/cu.mm
❖ Chikungunya
➢ Chikungunya means that which bend up (मुड़ना)
➢ It is a viral disease first report from Africa
➢ Chikungunya symptom patient walk in a bend posture due to joint pain
➢ It is transmission by Aedes aegypti (एडीस एदजप्टी) mosquito
Clinical symptom
➢ Chills with fever
➢ Nausea & vomiting
➢ Headache
➢ Severe joint pain
➢ Rash
➢ Mouth ulce
r ➢ conjunctivitis
Diagnosis test
➢ Enzyme-Linked Immunosorbent Assay (ELISA test ) is confirmation test
Primary management and referral
➢ Antipyretic drug
➢ IV fluid
➢ Rest
➢ Antivirus drug
➢ Do not aspirin
➢ Do not NSAID- this drug risk for bleeding
Prevention
➢ Proper water drainage system
➢ Production of skin
➢ Vaccine for chikungunya
❖ Yellow fever
➢ Yellow fever is a viral infection spread by a particular Aedes aegypti mosquito.
➢ The infection is most common in areas of Africa and South America
➢ Incubation period — 3 to 6 day
Symptoms
➢ Feve
r ➢ Headache
➢ Muscle pain, particularly in your back and knees
➢ Sensitivity to light
➢ Nausea & vomiting or both
➢ Loss of appetite
➢ Yellowing of your skin and the whites of your eyes (jaundice)
➢ Decreased urination
➢ Bleeding from your nose, mouth and eyes
➢ Liver and kidney failure
Treatment
➢ No antiviral medications
➢ proved helpful in treating yellow fever.
➢ Give the supportive care in a hospital.
➢ This includes providing fluids and oxygen, maintaining adequate blood pressure
➢ providing dialysis for kidney failure
➢ Treating any other infections that develop
➢ Vaccine for yellow fever
❖ Zika fever
➢ The Zika virus is most often spread to people through Aedes aegypti mosquito
➢ Zika virus may cause brain or nervous system complications such as Guillain-Barre syndrome
➢ Zika virus is also called Zika, Zika fever or Zika virus disease
➢ Zika virus infection during pregnancy also increases the risk of serious birth defects in infants, including a Microcephaly.
Signs and symptoms
➢ Mild fever ➢ Rash ➢ Joint pain, particularly in the hands or feet ➢ Red eyes (conjunctivitis) ➢ Muscle pain ➢ Headache ➢ Eye pain ➢ Fatigue or a general feeling of discomfort ➢ Abdominal pain Diagnosis test ➢ blood or urine test to confirm the diagnosis.
Treatment
➢ There is no specific treatment for infection with the Zika virus.
➢ To help relieve symptoms by rest and drink fluids to prevent dehydration.
➢ The medication acetaminophen help relieve joint pain and fever.
➢ Don't take ibuprofen or aspirin. These medications can increase the risk of serious complications
❖ Mosquito control measures
(A) Anti larval measures
1. Environmental control - cleanness surrounding area
2. Chemical control- bye the use of kerosene
3. Biological control- Done by using a eating fish known as Gambusia (िांबुदसया मछली)
(B) Anti Adult Measure
1. Residual spray- Malathion
2. Space spray- DDT fogging
3. Genetic control - depend on gene
(C) Personal protection
1. Mosquito net
2. Screening
3. Repellents Disease Vector/ transmitted by Cause Malaria Anopheles mosquito Plasmodium filaria Culex Wucheria bancrofti kalaazar Sand fly Leishmania donovani Japanese encephalitis Culex Virus Dengue Aedes Virus chikungunya Aedes Virus Yellow fever Aedes Virus Zika infection Aedes Virus